Provider Demographics
NPI:1093830481
Name:NUNNERY, MARIENA LOUISE
Entity Type:Individual
Prefix:
First Name:MARIENA
Middle Name:LOUISE
Last Name:NUNNERY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4145 SHADOW LN
Mailing Address - Street 2:APT.#527
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-5265
Mailing Address - Country:US
Mailing Address - Phone:915-345-4077
Mailing Address - Fax:
Practice Address - Street 1:599 TOMALES
Practice Address - Street 2:CLINIC
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-5000
Practice Address - Country:US
Practice Address - Phone:707-765-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical Technologist