Provider Demographics
NPI:1902968852
Name:MARNIN, VICKI NOLAN (CNM)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:NOLAN
Last Name:MARNIN
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 1:240 CROSS ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-3143
Mailing Address - Country:US
Mailing Address - Phone:860-349-0731
Mailing Address - Fax:
Practice Address - Street 1:943 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:CT
Practice Address - Zip Code:06443-3236
Practice Address - Country:US
Practice Address - Phone:203-318-8884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTLMN0240176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife