Provider Demographics
NPI:1619337094
Name:CHURNESS, DANA MARIE (CLC, CPM, CD(DONA))
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:MARIE
Last Name:CHURNESS
Suffix:
Gender:F
Credentials:CLC, CPM, CD(DONA)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86495 LENAWEE RD
Mailing Address - Street 2:
Mailing Address - City:HERBSTER
Mailing Address - State:WI
Mailing Address - Zip Code:54844-4404
Mailing Address - Country:US
Mailing Address - Phone:715-813-0441
Mailing Address - Fax:
Practice Address - Street 1:86495 LENAWEE RD
Practice Address - Street 2:
Practice Address - City:HERBSTER
Practice Address - State:WI
Practice Address - Zip Code:54844-4404
Practice Address - Country:US
Practice Address - Phone:715-813-0441
Practice Address - Fax:715-292-6472
Is Sole Proprietor?:No
Enumeration Date:2016-02-29
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI00016821174H00000X
MN174N00000X
WI147176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No174H00000XOther Service ProvidersHealth Educator
No174N00000XOther Service ProvidersLactation Consultant, Non-RN