Healthcare Provider Details

I. General information

NPI: 1518389972
Provider Name (Legal Business Name): LINDSAY C MARSHA R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2014
Last Update Date: 01/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

434 LAPHAM MILLS RD
PERU NY
12972-5030
US

IV. Provider business mailing address

434 LAPHAM MILLS RD
PERU NY
12972-5030
US

V. Phone/Fax

Practice location:
  • Phone: 802-535-8078
  • Fax:
Mailing address:
  • Phone: 802-535-8078
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number677558-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: