Provider Demographics
NPI:1992217913
Name:CORSON, MARCIA LYN (CNM)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:LYN
Last Name:CORSON
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 1:212 W DALE ST STE 402
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50703-1954
Mailing Address - Country:US
Mailing Address - Phone:319-235-3865
Mailing Address - Fax:319-235-3873
Practice Address - Street 1:212 W DALE ST STE 402
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50703-1954
Practice Address - Country:US
Practice Address - Phone:319-235-3865
Practice Address - Fax:319-235-3873
Is Sole Proprietor?:No
Enumeration Date:2017-10-31
Last Update Date:2017-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAB093700367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife