Healthcare Provider Details

I. General information

NPI: 1073096020
Provider Name (Legal Business Name): ELIZABETH MARSHALL NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH MARSHALL

II. Dates (important events)

Enumeration Date: 09/14/2018
Last Update Date: 04/08/2022
Certification Date: 04/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL CENTER DR
MORGANTOWN WV
26506-1200
US

IV. Provider business mailing address

1 MEDICAL CENTER DR
MORGANTOWN WV
26506-1200
US

V. Phone/Fax

Practice location:
  • Phone: 877-988-4478
  • Fax:
Mailing address:
  • Phone: 877-988-4478
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number89197
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: