Provider Demographics
NPI:1386130037
Name:MARCHAND, ALISHA M (CNM)
Entity type:Individual
Prefix:
First Name:ALISHA
Middle Name:M
Last Name:MARCHAND
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 1:5984 DOUGLAS RD
Mailing Address - Street 2:
Mailing Address - City:IDA
Mailing Address - State:MI
Mailing Address - Zip Code:48140-9723
Mailing Address - Country:US
Mailing Address - Phone:734-770-8287
Mailing Address - Fax:
Practice Address - Street 1:2751 BAY PARK DR STE 300
Practice Address - Street 2:
Practice Address - City:OREGON
Practice Address - State:OH
Practice Address - Zip Code:43616-4922
Practice Address - Country:US
Practice Address - Phone:419-690-7596
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-05
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704261457NSA18624367A00000X
OHAPRN.CNM.019375367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0310929Medicaid