Healthcare Provider Details

I. General information

NPI: 1245107705
Provider Name (Legal Business Name): MARY ANNE MARSHALL RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2025
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5688 RED FERN CT
LITTLETON CO
80125-9088
US

IV. Provider business mailing address

5688 RED FERN CT
LITTLETON CO
80125-9088
US

V. Phone/Fax

Practice location:
  • Phone: 720-965-4112
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number633967
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberRN.1706250
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: