Active NPI
Lynnique Marshall
- Specialist
- Henrico, VA
National Provider Identifier
1689481830
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 1201079970
- Practice address
- 4501 S Laburnum Ave Ste 119
Henrico, VA 23231-2489 - Phone
- (804) 767-3553
- NPI assigned
- Dec 11, 2024
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Specialist | 174400000X | 1201079970 | VA | Primary |
Addresses
Primary practice location
4501 S Laburnum Ave Ste 119
Henrico, VA 23231-2489
Mailing address
223 Carlstone Dr
Henrico, VA 23075-2502
Phone (804) 690-1739
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 |
|---|---|---|---|
| 1201079970 | VA | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1733875200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1733875200000",
"number": "1689481830",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "223 CARLSTONE DR",
"city": "HENRICO",
"state": "VA",
"postal_code": "230752502",
"telephone_number": "804-690-1739"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4501 S LABURNUM AVE STE 119",
"city": "HENRICO",
"state": "VA",
"postal_code": "232312489",
"telephone_number": "804-767-3553"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARSHALL",
"first_name": "LYNNIQUE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-12-11",
"last_updated": "2024-12-11",
"certification_date": "2024-12-11",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "VA",
"license": "1201079970",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Henrico, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.