Provider Demographics
NPI:1306371455
Name:MARINEY, DANICE B (RN IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:DANICE
Middle Name:B
Last Name:MARINEY
Suffix:
Gender:F
Credentials:RN IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:200 CRESCENT CENTER PKWY
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-7047
Mailing Address - Country:US
Mailing Address - Phone:770-496-3676
Mailing Address - Fax:770-496-3709
Practice Address - Street 1:200 CRESCENT CENTER PKWY
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-7047
Practice Address - Country:US
Practice Address - Phone:770-496-3676
Practice Address - Fax:770-496-3709
Is Sole Proprietor?:No
Enumeration Date:2017-04-26
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA042100163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant