Healthcare Provider Details

I. General information

NPI: 1609706217
Provider Name (Legal Business Name): TETYANA MARSHALL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2026
Last Update Date: 05/23/2026
Certification Date: 05/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 WASHINGTON AVE S STE 900
MINNEAPOLIS MN
55401-2455
US

IV. Provider business mailing address

100 WASHINGTON AVE S STE 900
MINNEAPOLIS MN
55401-2455
US

V. Phone/Fax

Practice location:
  • Phone: 866-492-5336
  • Fax:
Mailing address:
  • Phone: 866-492-5336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number88197
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: