Healthcare Provider Details

I. General information

NPI: 1497027767
Provider Name (Legal Business Name): SUSAN MARIE MARSHALL M.S., COMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2012
Last Update Date: 02/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6900 PECOS RD
NORTH LAS VEGAS NV
89086-4400
US

IV. Provider business mailing address

6900 PECOS RD
NORTH LAS VEGAS NV
89086-4400
US

V. Phone/Fax

Practice location:
  • Phone: 702-791-9000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255R0406X
TaxonomyBlind Rehabilitation Specialist/Technologist
License Number4916
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: