Healthcare Provider Details

I. General information

NPI: 1215035142
Provider Name (Legal Business Name): MARIANNE POWER LM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 04/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 E HIBISCUS DR
LAKELAND FL
33803-2913
US

IV. Provider business mailing address

205 E HIBISCUS DR
LAKELAND FL
33803-2913
US

V. Phone/Fax

Practice location:
  • Phone: 863-660-0048
  • Fax: 863-682-1644
Mailing address:
  • Phone: 863-660-0048
  • Fax: 863-682-1644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberMW92
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: