Provider Demographics
NPI:1427139393
Name:MARLIN, HEIDI NIKOLE (MD)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:NIKOLE
Last Name:MARLIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 24
Mailing Address - Street 2:195 STAFFORD LANE
Mailing Address - City:DELTA
Mailing Address - State:CO
Mailing Address - Zip Code:81416-0024
Mailing Address - Country:US
Mailing Address - Phone:970-874-6823
Mailing Address - Fax:970-874-6903
Practice Address - Street 1:195 STAFFORD LN
Practice Address - Street 2:
Practice Address - City:DELTA
Practice Address - State:CO
Practice Address - Zip Code:81416-2229
Practice Address - Country:US
Practice Address - Phone:970-874-6823
Practice Address - Fax:970-874-6903
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO44831207Q00000X, 207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO87436531Medicaid
COCO303973Medicare PIN