Healthcare Provider Details

I. General information

NPI: 1972453769
Provider Name (Legal Business Name): ALEXIA MARSHALL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2026
Last Update Date: 01/30/2026
Certification Date: 01/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 E CARPENTER ST
SPRINGFIELD IL
62702-5324
US

IV. Provider business mailing address

134 N DOUGLAS AVE
SPRINGFIELD IL
62702-4814
US

V. Phone/Fax

Practice location:
  • Phone: 217-544-6464
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number041529499
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: