Healthcare Provider Details

I. General information

NPI: 1134030307
Provider Name (Legal Business Name): ABIGAIL RUTH MARSHALL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

939 WILSON RD
EAST LANSING MI
48824-6410
US

IV. Provider business mailing address

760 QUEEN ST EAST APT 1
SAULT STE. MARIE ONTARIO
P6A 3Y1
CA

V. Phone/Fax

Practice location:
  • Phone: 517-355-1855
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: