MEDICARE: MRS. LARA ASHLEY MARSHALL CNM

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	367A00000X	Advanced Practice Midwife	489	NC
2	367A00000X	Advanced Practice Midwife	236282	CA

General Provider Information

NPI Number	:	1699043554
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LARA ASHLEY MARSHALL CNM

Provider Business Mailing Address
First Line	:	1908 N BEALE RD
Second Line	:
City	:	MARYSVILLE
State	:	CA
Zip	:	95901-6937
Country	:	US
Telephone Number	:	530-645-7336
Fax Number	:	530-743-9823

Provider Business Practice Location Address
First Line	:	1908 N BEALE RD
Second Line	:
City	:	MARYSVILLE
State	:	CA
Zip	:	95901-6937
Country	:	US
Telephone Number	:	530-645-7336
Fax Number	:	530-743-9823

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

Provider Enumeration Date	:	12/07/2011
Last Update Date	:	08/16/2023

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