Provider Demographics
NPI:1639302953
Name:LOMINY, MANOUCHKA (ANP)
Entity Type:Individual
Prefix:MRS
First Name:MANOUCHKA
Middle Name:
Last Name:LOMINY
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:MS
Other - First Name:MARIE
Other - Middle Name:MANOUCHKA
Other - Last Name:BELLERICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:721 LAUREL CHASE SW
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-3968
Mailing Address - Country:US
Mailing Address - Phone:770-429-0074
Mailing Address - Fax:
Practice Address - Street 1:1750 POWDER SPRINGS RD SW STE 510
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-4849
Practice Address - Country:US
Practice Address - Phone:770-875-8889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-02
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA190413363LW0102X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health