Provider Demographics
NPI:1982208625
Name:MARKGRAF, HAILEI MORGAN
Entity Type:Individual
Prefix:
First Name:HAILEI
Middle Name:MORGAN
Last Name:MARKGRAF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:451 MAIN ST STE 7
Mailing Address - Street 2:
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-5637
Mailing Address - Country:US
Mailing Address - Phone:530-503-7307
Mailing Address - Fax:
Practice Address - Street 1:451 MAIN ST STE 7
Practice Address - Street 2:
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-5637
Practice Address - Country:US
Practice Address - Phone:530-503-7307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-23
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA80387Medicaid