Basic Information
| Provider Information | |||||||||
| NPI: | 1871654996 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MARSHALL | ||||||||
| FirstName: | MAURA | ||||||||
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| Credential: | ARNP, MSN, CCRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 380 LAFAYETTE RD | ||||||||
| Address2: | |||||||||
| City: | HAMPTON | ||||||||
| State: | NH | ||||||||
| PostalCode: | 038422222 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6039260088 | ||||||||
| FaxNumber: | 6039262853 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 MCGREGOR ST | ||||||||
| Address2: | |||||||||
| City: | MANCHESTER | ||||||||
| State: | NH | ||||||||
| PostalCode: | 031023730 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6036636472 | ||||||||
| FaxNumber: | 6036636645 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/12/2006 | ||||||||
| LastUpdateDate: | 05/04/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 034969-21 | NH | N | Nursing Service Providers | Registered Nurse | 363LF0000X | 034969-23-03 | NH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 0711730 | 05 | MA | MEDICAID | 30342305 | 05 | NH | MEDICAID | 01Y002612NH04 | 01 | NH | ANTHEM | OTHER |