MEDICARE: MARJORIE ANNE DACKO CM

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	176B00000X	Midwife	NMA601	NV

General Provider Information

NPI Number	:	1437441805
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARJORIE ANNE DACKO CM

Provider Business Mailing Address
First Line	:	1700 E DESERT INN RD
Second Line	:	SUITE 100
City	:	LAS VEGAS
State	:	NV
Zip	:	89169-3242
Country	:	US
Telephone Number	:	702-433-8533
Fax Number	:	702-433-8533

Provider Business Practice Location Address
First Line	:	1700 E DESERT INN RD
Second Line	:	SUITE 100
City	:	LAS VEGAS
State	:	NV
Zip	:	89169-3242
Country	:	US
Telephone Number	:	702-433-8533
Fax Number	:	702-433-8533

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

Provider Enumeration Date	:	05/04/2011
Last Update Date	:	05/04/2011

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