Healthcare Provider Details

I. General information

NPI: 1710228606
Provider Name (Legal Business Name): HEATHER M MARSHALL RN, MSN CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2013
Last Update Date: 09/30/2025
Certification Date: 09/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 MOTE DR
COVINGTON OH
45318-1260
US

IV. Provider business mailing address

3170 KETTERING BLVD BLDG B
MORAINE OH
45439-1924
US

V. Phone/Fax

Practice location:
  • Phone: 372-089-0109
  • Fax: 937-208-9020
Mailing address:
  • Phone: 937-991-3188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.293630
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCOA.14724-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: