Individual
MRS. MARIAH MARIANNE VAN DYKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LM, CPM
Contact information
Practice address
1727 SOUTH ST, REDDING, CA 96001-1812
(530) 722-7569
Mailing address
2134 VICTOR AVE, REDDING, CA 96002-0407
(530) 722-7569
Taxonomy
Speciality
Code
Description
License number
State
176B00000X
Midwife
Primary
LM691
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CPM22080027
NARM
—
01
—
LM691
MEDICAL BOARD OF CALIFORNIA
CA
Enumeration date
10/24/2022
Last updated
10/24/2022
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