Provider Demographics
NPI:1124120662
Name:PLATT, MARILYN MARIE (CNM)
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:MARIE
Last Name:PLATT
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19245 LENCA RD
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307-4705
Mailing Address - Country:US
Mailing Address - Phone:760-946-5217
Mailing Address - Fax:
Practice Address - Street 1:16051 KASOTA RD
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-2215
Practice Address - Country:US
Practice Address - Phone:760-946-8169
Practice Address - Fax:760-946-8875
Is Sole Proprietor?:No
Enumeration Date:2006-09-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANMW 923176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANMW923OtherMID-WIFERY LICENSE