Doctor Name: | TERRISA R MUSTARD-MARSHALL |
NPI Number: | 1760652515 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LMP |
License Number: | MA00024827 |
Business Practice Address: | 4323 Rucker Ave A Everett, WA - 982032213 |
Business Phone Number: | 4253144842 |
Business Fax Number: | 4253392221 |
Mailing Address: | 10110 19th Ave Se, E-102 EVERETT |
State: | WA |
Postal Code: | 982084249 |
Phone Number: | 4253144842 |
Fax Number: | 4253392221 |
NPI Enumeration Date: | 03/07/2008 |
NPI Last Update Date: | 03/07/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | MA00024827 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WA |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |