=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548183619
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DRAKE E MARSHALL FNP-C
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/04/2026
-----------------------------------------------------
Last Update Date | 08/04/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3500 FRANCISCAN WAY
-----------------------------------------------------
City | MICHIGAN CITY
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46360-0033
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 219-331-5706
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2805 DOUBLE EAGLE LN APT J
-----------------------------------------------------
City | VALPARAISO
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46383-2853
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 219-331-5706
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 390200000X
-----------------------------------------------------
Taxonomy Name | Student in an Organized Health Care Education/Training Program
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------