Provider Demographics
NPI:1114200490
Name:HEATON, MARILYN MARIE
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:MARIE
Last Name:HEATON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:MARIE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18381 S AVE 3 1/2 E
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85365-4725
Mailing Address - Country:US
Mailing Address - Phone:928-259-4638
Mailing Address - Fax:
Practice Address - Street 1:18381 S AVE 3 1/2 E
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85365-4725
Practice Address - Country:US
Practice Address - Phone:928-259-4638
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-23
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator