MEDICARE: MS. SUSAN ELAINE MARSHALL FNPC/CPNP

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	363LP2300X	Primary Care Nurse Practitioner	201903	NC

General Provider Information

NPI Number	:	1720252729
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUSAN ELAINE MARSHALL FNPC/CPNP

Provider Business Mailing Address
First Line	:	110 PRESTON EXECUTIVE DR
Second Line	:	SUITE 108
City	:	CARY
State	:	NC
Zip	:	27513-8447
Country	:	US
Telephone Number	:	919-852-3999
Fax Number	:	919-852-3444

Provider Business Practice Location Address
First Line	:	110 PRESTON EXECUTIVE DR
Second Line	:	SUITE 108
City	:	CARY
State	:	NC
Zip	:	27513-8447
Country	:	US
Telephone Number	:	919-852-3999
Fax Number	:	919-852-3444

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

Provider Enumeration Date	:	04/22/2008
Last Update Date	:	04/29/2010

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