MEDICARE: MR. TIMOTHY MARSHALL

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1811849144
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TIMOTHY MARSHALL

Provider Business Mailing Address
First Line	:	PO BOX 149
Second Line	:
City	:	SEBASTOPOL
State	:	CA
Zip	:	95473-0149
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	320 10TH ST STE 200
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95401-5291
Country	:	US
Telephone Number	:	707-579-0465
Fax Number	:

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

Provider Enumeration Date	:	02/10/2026
Last Update Date	:	02/10/2026

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