Healthcare Provider Details

I. General information

NPI: 1144172677
Provider Name (Legal Business Name): AMY MARSHALL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9320 KRIS DR
WHITE PLAINS MD
20695-2933
US

IV. Provider business mailing address

9320 KRIS DR
WHITE PLAINS MD
20695-2933
US

V. Phone/Fax

Practice location:
  • Phone: 240-975-5303
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR197148
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR197148
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: