Provider Demographics
NPI:1003187261
Name:MARSHALL, HEIDI (LM, CPM)
Entity type:Individual
Prefix:MS
First Name:HEIDI
Middle Name:
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-4926
Mailing Address - Country:US
Mailing Address - Phone:707-671-7476
Mailing Address - Fax:707-671-7478
Practice Address - Street 1:530 S MAIN ST
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-4926
Practice Address - Country:US
Practice Address - Phone:707-671-7476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-19
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA263176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife