Healthcare Provider Details

I. General information

NPI: 1851406011
Provider Name (Legal Business Name): LINDSEY ELIZABETH MARSHALL PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 03/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 PARK AVE. BLDG. D STE. 100
PARK CITY UT
84060
US

IV. Provider business mailing address

200 W ARBOR DR #8894
SAN DIEGO CA
92103-9001
US

V. Phone/Fax

Practice location:
  • Phone: 435-615-8822
  • Fax: 435-615-8823
Mailing address:
  • Phone: 619-543-2542
  • Fax: 619-543-2540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-00485
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number8599800-1206
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number20419
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number2516
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: