Provider Demographics
NPI:1295127892
Name:STATON, MARSHA
Entity type:Individual
Prefix:
First Name:MARSHA
Middle Name:
Last Name:STATON
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 1:129 WILDWOOD AVE
Mailing Address - Street 2:E
Mailing Address - City:RIO DELL
Mailing Address - State:CA
Mailing Address - Zip Code:95562-1723
Mailing Address - Country:US
Mailing Address - Phone:707-764-3139
Mailing Address - Fax:707-269-9074
Practice Address - Street 1:129 WILDWOOD AVE
Practice Address - Street 2:E
Practice Address - City:RIO DELL
Practice Address - State:CA
Practice Address - Zip Code:95562-1723
Practice Address - Country:US
Practice Address - Phone:707-764-3139
Practice Address - Fax:707-269-9074
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-19
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA209391363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily