Provider Demographics
NPI:1023292067
Name:MARSHALL, CHELSEA GENNA (PA-C)
Entity type:Individual
Prefix:MRS
First Name:CHELSEA
Middle Name:GENNA
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3550 N UNIVERSITY AVE
Mailing Address - Street 2:STE 250
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-6685
Mailing Address - Country:US
Mailing Address - Phone:801-374-9625
Mailing Address - Fax:801-374-9690
Practice Address - Street 1:1861 KINGSLEY RD. #80
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401
Practice Address - Country:US
Practice Address - Phone:503-569-9607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-27
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT71069781206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant