1023081403 NPI number — JENNIFER L MARSHALL M.D.

Table of content: JENNIFER L MARSHALL M.D. (NPI 1023081403)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023081403 NPI number — JENNIFER L MARSHALL M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARSHALL
Provider First Name:
JENNIFER
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1023081403
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/18/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2290
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MANITOWOC
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54221-2290
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
920-320-2591
Provider Business Mailing Address Fax Number:
920-320-4155

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2300 WESTERN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANITOWOC
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54220-3712
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
920-320-2564
Provider Business Practice Location Address Fax Number:
920-320-2201
Provider Enumeration Date:
02/08/2006

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: 207L00000X , with the licence number:  56500 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 20200396 . This is a "PRESBYTERIAN HP" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: NM009T97 . This is a "BCBS" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 41729595 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10019287 . This is a "LOVELACE HP" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: T0396 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01330869 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 941410 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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