Provider Demographics
NPI:1639519515
Name:BEARDEN, MARSHA MALENA (RN, IBCLC, RLC)
Entity Type:Individual
Prefix:MRS
First Name:MARSHA
Middle Name:MALENA
Last Name:BEARDEN
Suffix:
Gender:F
Credentials:RN, IBCLC, RLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14924 AL HIGHWAY 68
Mailing Address - Street 2:
Mailing Address - City:CROSSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35962-3404
Mailing Address - Country:US
Mailing Address - Phone:256-528-7953
Mailing Address - Fax:
Practice Address - Street 1:14924 AL HIGHWAY 68
Practice Address - Street 2:
Practice Address - City:CROSSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35962-3404
Practice Address - Country:US
Practice Address - Phone:256-528-7953
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-25
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-049745163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant