MEDICARE: MICHAEL MARSHALL APRN, PMHNP

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	95028122	CA
2	163W00000X	Registered Nurse	679231	CA

General Provider Information

NPI Number	:	1245563543
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL MARSHALL APRN, PMHNP

Provider Business Mailing Address
First Line	:	3200 E GUASTI RD
Second Line	:
City	:	ONTARIO
State	:	CA
Zip	:	91761-8660
Country	:	US
Telephone Number	:	909-755-6610
Fax Number	:	909-385-3335

Provider Business Practice Location Address
First Line	:	3200 E GUASTI RD
Second Line	:
City	:	ONTARIO
State	:	CA
Zip	:	91761-8660
Country	:	US
Telephone Number	:	909-755-6610
Fax Number	:	909-385-3335

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

Provider Enumeration Date	:	09/17/2009
Last Update Date	:	02/24/2026

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