Healthcare Provider Details

I. General information

NPI: 1396078044
Provider Name (Legal Business Name): RONNIE DARRIN MARSHALL RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2009
Last Update Date: 09/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 TALUS WAY
RENO NV
89503-1216
US

IV. Provider business mailing address

390 TALUS WAY
RENO NV
89503-1216
US

V. Phone/Fax

Practice location:
  • Phone: 775-240-2865
  • Fax: 775-688-3388
Mailing address:
  • Phone: 775-240-2865
  • Fax: 775-688-3388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License NumberRN 30344
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: