MEDICARE: MARQUISHA STALLING

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	172V00000X	Community Health Worker
2	175M00000X	Lay Midwife

General Provider Information

NPI Number	:	1992238174
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARQUISHA STALLING

Provider Business Mailing Address
First Line	:	506 E AVENUE J
Second Line	:	UNIT B
City	:	GRAND PRAIRIE
State	:	TX
Zip	:	75050-2517
Country	:	US
Telephone Number	:	972-697-9082
Fax Number	:

Provider Business Practice Location Address
First Line	:	506 E AVENUE J
Second Line	:	UNIT B
City	:	GRAND PRAIRIE
State	:	TX
Zip	:	75050-2517
Country	:	US
Telephone Number	:	972-697-9082
Fax Number	:

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

Provider Enumeration Date	:	04/05/2017
Last Update Date	:	04/05/2017

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Directions to “ MARQUISHA STALLING ” Practice Location

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