Healthcare Provider Details

I. General information

NPI: 1356206650
Provider Name (Legal Business Name): MARSHALL POULIN RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 LINDENWOOD DR
FORT COLLINS CO
80524-2236
US

IV. Provider business mailing address

1120 LINDENWOOD DR
FORT COLLINS CO
80524-2236
US

V. Phone/Fax

Practice location:
  • Phone: 719-330-2338
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberRN.1641150
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: