Provider Demographics
NPI:1770118150
Name:HEINRICHS, MARLENE
Entity type:Individual
Prefix:
First Name:MARLENE
Middle Name:
Last Name:HEINRICHS
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 1:208 S CORDELL AVE
Mailing Address - Street 2:
Mailing Address - City:CORDELL
Mailing Address - State:OK
Mailing Address - Zip Code:73632-5416
Mailing Address - Country:US
Mailing Address - Phone:580-660-1220
Mailing Address - Fax:
Practice Address - Street 1:208 S CORDELL AVE
Practice Address - Street 2:
Practice Address - City:CORDELL
Practice Address - State:OK
Practice Address - Zip Code:73632-5416
Practice Address - Country:US
Practice Address - Phone:580-660-1220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-06
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist