MEDICARE: KIRSTEN INGRID MARSHALL CNP

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	APRN.CNP.025670	OH

General Provider Information

NPI Number	:	1578103586
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIRSTEN INGRID MARSHALL CNP

Provider Business Mailing Address
First Line	:	18099 LORAIN AVE STE 525
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44111-5611
Country	:	US
Telephone Number	:	216-492-3151
Fax Number	:

Provider Business Practice Location Address
First Line	:	18099 LORAIN AVE STE 525
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44111-5611
Country	:	US
Telephone Number	:	216-492-3151
Fax Number	:

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

Provider Enumeration Date	:	01/08/2020
Last Update Date	:	03/24/2026

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