Provider Demographics
NPI:1255052205
Name:MEEHLEIB, MARSHA SLOSAROVA (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:MARSHA
Middle Name:SLOSAROVA
Last Name:MEEHLEIB
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24902 PAPPAS RD
Mailing Address - Street 2:
Mailing Address - City:RAMONA
Mailing Address - State:CA
Mailing Address - Zip Code:92065-4918
Mailing Address - Country:US
Mailing Address - Phone:858-335-3895
Mailing Address - Fax:
Practice Address - Street 1:24902 PAPPAS RD
Practice Address - Street 2:
Practice Address - City:RAMONA
Practice Address - State:CA
Practice Address - Zip Code:92065-4918
Practice Address - Country:US
Practice Address - Phone:858-335-3895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-08
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA627696163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty