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General NPI Number Information
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NPI Number | 1376939561
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Entity Type | Individual
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Provider Name | JACKIE SUE MARSHALL
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Gender | Female
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Dates
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Enumeration Date | 04/14/2015
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Last Update Date | 04/14/2015
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Provider Practice Location Address
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Address Line | 5734 E RANCHO MANANA BLVD STE 4
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City | CAVE CREEK
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State | AZ
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Zip | 85331-8513
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Country | US
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Telephone | 602-930-9568
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Fax | 480-502-3688
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Provider Business Mailing Address
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Address Line | 4249 E ANDREA DR
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City | CAVE CREEK
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State | AZ
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Zip | 85331-2631
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Country | US
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Telephone | 602-930-9568
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Fax | 480-502-3688
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174H00000X
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Taxonomy Name | Health Educator
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License Number |
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License Number State |
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