Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Ethan Tyler Marshall

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1366292799

Ethan Tyler Marshall is a Student in an Organized Health Care Education/Training Program in Peoria, Illinois. Registered with an NPI since 2024.

In the registry since
2024

Practice location Address checks out

530 NE Glen Oak Ave
Peoria, IL 61637-0001
Phone: (507) 220-1519
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Student in an Organized Health Care Education/Training Program (primary) Taxonomy 390200000X

Record details

NPI number1366292799
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedMarch 26, 2024
Last updated in NPPESMarch 26, 2024
Certification dateMarch 26, 2024
Mailing address409 W Bishop St, Luverne, MN 56156-1203

Other providers in Peoria