Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 44831 | CO |
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 44831 | CO |
NPI | 1427139393 |
---|---|
Provider Name | Heidi Nikole Marlin |
First Address | Delta, CO 81416-0024 |
Second Address | Delta, CO 81416-2229 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2006 |
Last Update Date | 30/12/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
87436531 | (05) | CO |