Provider Demographics
NPI:1174259097
Name:BIERL, MARISSA (IBCLC)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:
Last Name:BIERL
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1064 SWEET RD
Mailing Address - Street 2:
Mailing Address - City:EAST AURORA
Mailing Address - State:NY
Mailing Address - Zip Code:14052-2834
Mailing Address - Country:US
Mailing Address - Phone:716-445-8550
Mailing Address - Fax:
Practice Address - Street 1:121 ELM ST
Practice Address - Street 2:
Practice Address - City:EAST AURORA
Practice Address - State:NY
Practice Address - Zip Code:14052-2535
Practice Address - Country:US
Practice Address - Phone:716-780-2662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-25
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
L-305964174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN