Healthcare Provider Details

I. General information

NPI: 1083824759
Provider Name (Legal Business Name): MICHELE LYNN MARSHALL RN, CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 PHILADELPHIA DR
DAYTON OH
45406-1813
US

IV. Provider business mailing address

1661 OWENS ROAD
PLEASANT HILL OH
45359
US

V. Phone/Fax

Practice location:
  • Phone: 937-278-2612
  • Fax:
Mailing address:
  • Phone: 937-676-3954
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License NumberNS-06041
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: