Provider Demographics
NPI:1376117143
Name:MARKLAND, HEIDI (LAC)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:MARKLAND
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4349 W DUNKIRK AVE APT 344
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-1200
Mailing Address - Country:US
Mailing Address - Phone:208-416-7405
Mailing Address - Fax:
Practice Address - Street 1:610 HUBBARD AVE
Practice Address - Street 2:STE 122
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814
Practice Address - Country:US
Practice Address - Phone:208-416-7405
Practice Address - Fax:208-277-0912
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-17
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDACU-420171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist