Healthcare Provider Details

I. General information

NPI: 1982204053
Provider Name (Legal Business Name): ALEXANDRIA MARIE MARSHALL RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2020
Last Update Date: 12/03/2020
Certification Date: 12/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7149 WALTON RD
WALTON HILLS OH
44146-4358
US

IV. Provider business mailing address

7149 WALTON RD
WALTON HILLS OH
44146-4358
US

V. Phone/Fax

Practice location:
  • Phone: 216-559-1571
  • Fax:
Mailing address:
  • Phone: 216-559-1571
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLD.09296
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: