Active NPI
Antia Lynn Marshall-Wallace
- Nurse's Aide
- Youngstown, OH
National Provider Identifier
1013528892
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse's Aide
- License
- 401777960815
- Practice address
- 258 Pasadena Ave
Youngstown, OH 44507-1527 - Phone
- (330) 951-3876
- NPI assigned
- Aug 13, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse's Aide | 376K00000X | 401777960815 | OH | Primary |
Addresses
Primary practice location
258 Pasadena Ave
Youngstown, OH 44507-1527
Mailing address
258 Pasadena Ave
Youngstown, OH 44507-1527
Phone (330) 951-3876
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 401777960815 | OH | MD | Nurse's Aide |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1597276800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1597276800000",
"number": "1013528892",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "258 PASADENA AVE",
"city": "YOUNGSTOWN",
"state": "OH",
"postal_code": "445071527",
"telephone_number": "330-951-3876"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "258 PASADENA AVE",
"city": "YOUNGSTOWN",
"state": "OH",
"postal_code": "445071527",
"telephone_number": "330-951-3876"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARSHALL-WALLACE",
"first_name": "ANTIA",
"middle_name": "LYNN",
"name_prefix": "Mrs.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-08-13",
"last_updated": "2020-08-13",
"certification_date": "2020-08-13",
"status": "A"
},
"taxonomies": [
{
"code": "376K00000X",
"taxonomy_group": "",
"desc": "Nurse's Aide",
"state": "OH",
"license": "401777960815",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Youngstown, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.