Provider Demographics
NPI:1689481830
Name:MARSHALL, LYNNIQUE
Entity type:Individual
Prefix:
First Name:LYNNIQUE
Middle Name:
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 CARLSTONE DR
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23075-2502
Mailing Address - Country:US
Mailing Address - Phone:804-690-1739
Mailing Address - Fax:
Practice Address - Street 1:4501 S LABURNUM AVE STE 119
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23231-2489
Practice Address - Country:US
Practice Address - Phone:804-767-3553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-11
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1201079970174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist