MEDICARE: HEIDI NIKOLE MARLIN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	44831	CO
2	207QH0002X	Hospice and Palliative Medicine (Family Medicine) Physician	44831	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427139393
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEIDI NIKOLE MARLIN M.D.

Provider Business Mailing Address
First Line	:	PO BOX 24
Second Line	:	195 STAFFORD LANE
City	:	DELTA
State	:	CO
Zip	:	81416-0024
Country	:	US
Telephone Number	:	970-874-6823
Fax Number	:	970-874-6903

Provider Business Practice Location Address
First Line	:	195 STAFFORD LN
Second Line	:
City	:	DELTA
State	:	CO
Zip	:	81416-2229
Country	:	US
Telephone Number	:	970-874-6823
Fax Number	:	970-874-6903

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	12/30/2014

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