Provider Demographics
NPI:1316796337
Name:MARLOW, HEIDI M (NP)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:M
Last Name:MARLOW
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1041 WHITMAN HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:LA FOLLETTE
Mailing Address - State:TN
Mailing Address - Zip Code:37766-6491
Mailing Address - Country:US
Mailing Address - Phone:937-408-7606
Mailing Address - Fax:
Practice Address - Street 1:2221 JACKSBORO PIKE STE A13
Practice Address - Street 2:
Practice Address - City:LA FOLLETTE
Practice Address - State:TN
Practice Address - Zip Code:37766-3098
Practice Address - Country:US
Practice Address - Phone:865-333-4770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-13
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN36298363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner