Provider Demographics
NPI:1689647729
Name:SHAUER, MARLA (CNM)
Entity Type:Individual
Prefix:
First Name:MARLA
Middle Name:
Last Name:SHAUER
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 TRANCAS ST 300
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-2921
Mailing Address - Country:US
Mailing Address - Phone:707-492-9236
Mailing Address - Fax:425-949-5377
Practice Address - Street 1:1141 PEAR TREE LN
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558
Practice Address - Country:US
Practice Address - Phone:707-254-1774
Practice Address - Fax:707-251-2993
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN966363367A00000X
CA1926367A00000X
CANMW 1926374700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No374700000XNursing Service Related ProvidersTechnician
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC007794614Medicaid
DC034579200Medicaid
DC400937100Medicaid
DC007794614Medicaid
DC034579200Medicaid