Provider Demographics
NPI:1922345685
Name:KMAK, MARIANNE (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:MARIANNE
Middle Name:
Last Name:KMAK
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7431 S IVY WAY
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-1509
Mailing Address - Country:US
Mailing Address - Phone:720-219-2994
Mailing Address - Fax:720-230-4898
Practice Address - Street 1:8200 S QUEBEC ST
Practice Address - Street 2:A-12
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-4411
Practice Address - Country:US
Practice Address - Phone:303-741-2550
Practice Address - Fax:720-230-4898
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-14
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0091589163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO163WL0100XOtherRN, IBCLC