MEDICARE: RAVEN 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	372600000X	Adult Companion	16331	TN
2	376J00000X	Homemaker	16331	TN
3	3747A0650X	Attendant Care Provider	16331	TN
4	3747P1801X	Personal Care Attendant	16331	TN

General Provider Information

NPI Number	:	1942694161
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAVEN MARSHALL

Provider Business Mailing Address
First Line	:	1665 BONNIE LN
Second Line	:	106
City	:	CORDOVA
State	:	TN
Zip	:	38016-0548
Country	:	US
Telephone Number	:	901-800-2770
Fax Number	:	901-800-2771

Provider Business Practice Location Address
First Line	:	9154 BLUFFTOP CV
Second Line	:
City	:	CORDOVA
State	:	TN
Zip	:	38018-7684
Country	:	US
Telephone Number	:	901-859-9830
Fax Number	:

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

Provider Enumeration Date	:	03/25/2015
Last Update Date	:	07/28/2015

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Directions to “ RAVEN MARSHALL ” Practice Location

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