MEDICARE: MRS. MARIANNA J TERHUNE CD, CMA, LS, CBE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374J00000X	Doula	374J00000X-DOULA-	CA

General Provider Information

NPI Number	:	1033436142
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARIANNA J TERHUNE CD, CMA, LS, CBE

Provider Business Mailing Address
First Line	:	1640 DITTY AVE
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95403-2637
Country	:	US
Telephone Number	:	707-482-6265
Fax Number	:

Provider Business Practice Location Address
First Line	:	1640 DITTY AVE
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95403-2637
Country	:	US
Telephone Number	:	707-482-6265
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/28/2010
Last Update Date	:	04/28/2010

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