Provider Demographics
NPI:1508505397
Name:MIGNONE, MARISSA NICOLE I (DOULA)
Entity Type:Individual
Prefix:MISS
First Name:MARISSA
Middle Name:NICOLE
Last Name:MIGNONE
Suffix:I
Gender:F
Credentials:DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1349
Mailing Address - Street 2:
Mailing Address - City:TRUCKEE
Mailing Address - State:CA
Mailing Address - Zip Code:96160-1349
Mailing Address - Country:US
Mailing Address - Phone:805-423-4274
Mailing Address - Fax:
Practice Address - Street 1:9705 HWY 267
Practice Address - Street 2:SUITE 5
Practice Address - City:TRUCKEE
Practice Address - State:CA
Practice Address - Zip Code:96161-9616
Practice Address - Country:US
Practice Address - Phone:805-423-4274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-01
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
99499OtherN/A