Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 8640 | NC |
NPI | 1073532644 |
---|---|
Provider Name | Dr. Melanie Kristen Marshall |
First Address | Spencer, NC 28159-0029 |
Second Address | Spencer, NC 28159-2065 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2006 |
Last Update Date | 11/08/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5902037 | (05) | NC |
5903242 | (05) | NC |