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General NPI Number Information
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NPI Number | 1619337094
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Entity Type | Individual
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Provider Name | DANA MARIE CHURNESS CLC, CPM, CD(DONA)
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Gender | Female
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Dates
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Enumeration Date | 02/29/2016
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Last Update Date | 02/29/2016
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Provider Practice Location Address
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Address Line | 86495 LENAWEE RD
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City | HERBSTER
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State | WI
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Zip | 54844-4404
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Country | US
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Telephone | 715-813-0441
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Fax | 715-292-6472
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Provider Business Mailing Address
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Address Line | 86495 LENAWEE RD
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City | HERBSTER
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State | WI
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Zip | 54844-4404
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Country | US
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Telephone | 715-813-0441
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174H00000X
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Taxonomy Name | Health Educator
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License Number | 00016821
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 174N00000X
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Taxonomy Name | Lactation Consultant (Non-RN)
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License Number |
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License Number State | MN
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Taxonomy #3
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Taxonomy Code | 176B00000X
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Taxonomy Name | Midwife
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License Number | 147
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License Number State | WI
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