Healthcare Provider Details

I. General information

NPI: 1982208625
Provider Name (Legal Business Name): HAILEI MORGAN MARKGRAF
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/23/2020
Last Update Date: 11/23/2020
Certification Date: 11/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 MAIN ST STE 7
PLACERVILLE CA
95667-5637
US

IV. Provider business mailing address

451 MAIN ST STE 7
PLACERVILLE CA
95667-5637
US

V. Phone/Fax

Practice location:
  • Phone: 530-503-7307
  • Fax:
Mailing address:
  • Phone: 530-503-7307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: