1164404463 NPI number — SHARON F MARSHALL RN GNP CS BC

Table of content: SHARON F MARSHALL RN GNP CS BC (NPI 1164404463)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164404463 NPI number — SHARON F MARSHALL RN GNP CS BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARSHALL
Provider First Name:
SHARON
Provider Middle Name:
F
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN GNP CS BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ROERICK
Provider Other First Name:
SHARON
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1164404463
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/18/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3723 WILLOW SPRINGS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MANVEL
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77578-4787
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
832-264-2133
Provider Business Mailing Address Fax Number:
281-412-4690

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3723 WILLOW SPRINGS DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANVEL
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77578-4787
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
832-264-2133
Provider Business Practice Location Address Fax Number:
281-412-4690
Provider Enumeration Date:
11/14/2005

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: 364SG0600X , with the licence number:  513451 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 112662504 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00041932 . This is a "PGA RAILROAD MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: NP0371 . This is a "BC/BS OF TEXAS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com