MEDICARE: JESSICA MARSHALL MSN, FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	5015037	NC

General Provider Information

NPI Number	:	1205506417
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA MARSHALL MSN, FNP-C

Provider Business Mailing Address
First Line	:	298 LINCOLN ST SW
Second Line	:
City	:	CONCORD
State	:	NC
Zip	:	28025-5469
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	298 LINCOLN ST SW
Second Line	:
City	:	CONCORD
State	:	NC
Zip	:	28025-5469
Country	:	US
Telephone Number	:	704-792-2313
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/18/2021
Last Update Date	:	09/18/2021

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