1558696500 NPI number — MRS. GENESE RILEY MARSHALL APN

Table of content: MRS. GENESE RILEY MARSHALL APN (NPI 1558696500)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558696500 NPI number — MRS. GENESE RILEY MARSHALL APN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARSHALL
Provider First Name:
GENESE
Provider Middle Name:
RILEY
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
APN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1558696500
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/11/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
212 MARSHALL ROAD
Provider Second Line Business Mailing Address:
PLATTE COUNTY HEALTH DEPARTMENT
Provider Business Mailing Address City Name:
PLATTE CITY
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64079-9761
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-858-2412
Provider Business Mailing Address Fax Number:
816-858-2087

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
212 MARSHALL RD
Provider Second Line Business Practice Location Address:
PLATTE COUNTY HEALTH DEPARTMENT
Provider Business Practice Location Address City Name:
PLATTE CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64079-9761
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-858-2412
Provider Business Practice Location Address Fax Number:
816-858-2087
Provider Enumeration Date:
10/08/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  2011037996 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)