Healthcare Provider Details

I. General information

NPI: 1760244339
Provider Name (Legal Business Name): HEIDI MARLIN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2024
Last Update Date: 01/29/2024
Certification Date: 01/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 E MARSHALL ST
RICHMOND VA
23298-5023
US

IV. Provider business mailing address

18112 RUBY HILL CT
MOSELEY VA
23120-1908
US

V. Phone/Fax

Practice location:
  • Phone: 804-628-1262
  • Fax:
Mailing address:
  • Phone: 575-520-0501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2100X
TaxonomyAcute Care Clinical Nurse Specialist
License Number0024181914
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: