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General NPI Number Information
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NPI Number | 1689481830
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Entity Type | Individual
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Provider Name | LYNNIQUE MARSHALL
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Gender | Female
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Dates
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Enumeration Date | 12/11/2024
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Last Update Date | 12/11/2024
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Provider Practice Location Address
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Address Line | 4501 S LABURNUM AVE STE 119
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City | HENRICO
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State | VA
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Zip | 23231-2489
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Country | US
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Telephone | 804-767-3553
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Fax |
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Provider Business Mailing Address
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Address Line | 223 CARLSTONE DR
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City | HENRICO
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State | VA
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Zip | 23075-2502
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Country | US
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Telephone | 804-690-1739
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Fax |
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 1201079970
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License Number State | VA
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