Most Relevant Information
Provider Data
| NPI Number: | 1003668252 |
| Provider Name: | NIA MARSHALL |
| Entity Type: | Individual |
| Taxonomy Code: | 390200000X |
| Specialty: | Student in an Organized Health Care Education/Training Program |
| License Number: |
Most Important Dates
| Enumeration Date: | 04/02/2024 |
| Last Updated: | 06/18/2024 |
Provider Practice Location
811 W WELLINGTON AVE
CHICAGO
IL
606575123
Practice Location Phone/Fax
| Phone: | 7738712188 |
| Fax: | 7738716353 |
Provider Mailing Location
1857 DUNELLON DR
LYNDHURST
OH
441243920
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |