Provider Demographics
NPI:1215035142
Name:POWER, MARIANNE (LM)
Entity Type:Individual
Prefix:MS
First Name:MARIANNE
Middle Name:
Last Name:POWER
Suffix:
Gender:F
Credentials:LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 E HIBISCUS DR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33803-2913
Mailing Address - Country:US
Mailing Address - Phone:863-660-0048
Mailing Address - Fax:863-682-1644
Practice Address - Street 1:205 E HIBISCUS DR
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-2913
Practice Address - Country:US
Practice Address - Phone:863-660-0048
Practice Address - Fax:863-682-1644
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMW92176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL340113800Medicaid