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NPI Code Detail

MEDICARE: ELIZABETH AMY MARSHALL C.R.N.P.

MEDICARE: ELIZABETH AMY MARSHALL C.R.N.P.
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
1363LP0200XPediatric Nurse Practitioner1-056378AL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1356332217
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELIZABETH AMY MARSHALL C.R.N.P.
Provider Business Mailing Address
First Line : 126 CLINIC DR
Second Line :
City : DOTHAN
State : AL
Zip : 36303-1980
Country : US
Telephone Number : 334-793-1881
Fax Number : 334-712-1815
Provider Business Practice Location Address
First Line : 126 CLINIC DR
Second Line :
City : DOTHAN
State : AL
Zip : 36303-1980
Country : US
Telephone Number : 334-793-1881
Fax Number : 334-712-1815
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/31/2005
Last Update Date : 07/08/2007

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