MEDICARE: TANIESHA MARINEY ADMINISTRATOR

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	376K00000X	Nurse's Aide		CO

General Provider Information

NPI Number	:	1578149167
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TANIESHA MARINEY ADMINISTRATOR

Provider Business Mailing Address
First Line	:	9511 NW 86TH TER
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64153-1445
Country	:	US
Telephone Number	:	172-033-3820
Fax Number	:

Provider Business Practice Location Address
First Line	:	9511 NW 86TH TER
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64153-1445
Country	:	US
Telephone Number	:	720-333-8200
Fax Number	:

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

Provider Enumeration Date	:	03/23/2021
Last Update Date	:	03/23/2021

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Directions to “ TANIESHA MARINEY ADMINISTRATOR” Practice Location

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