MEDICARE: DAMARIS N MARSHALL LPN.175813.MEDS-IV

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	164W00000X	Licensed Practical Nurse	LPN.175813.MEDS-IV	OH

General Provider Information

NPI Number	:	1528661204
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAMARIS N MARSHALL LPN.175813.MEDS-IV

Provider Business Mailing Address
First Line	:	1360 W 80TH ST APT 204
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44102-1948
Country	:	US
Telephone Number	:	216-387-7967
Fax Number	:

Provider Business Practice Location Address
First Line	:	1360 W 80TH ST APT 204
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44102-1948
Country	:	US
Telephone Number	:	216-387-7967
Fax Number	:

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

Provider Enumeration Date	:	11/17/2020
Last Update Date	:	11/17/2020

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