Provider Demographics
NPI:1043728330
Name:GIERISH, MARINA LOUISE (BSN)
Entity Type:Individual
Prefix:
First Name:MARINA
Middle Name:LOUISE
Last Name:GIERISH
Suffix:
Gender:F
Credentials:BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20856 N 88TH DR
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-6433
Mailing Address - Country:US
Mailing Address - Phone:623-910-9494
Mailing Address - Fax:
Practice Address - Street 1:20856 N 88TH DR
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-6433
Practice Address - Country:US
Practice Address - Phone:623-910-9494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-20
Last Update Date:2018-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN110828163WX1500X, 163WC0400X, 163WI0500X, 163WW0000X, 163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WX1500XNursing Service ProvidersRegistered NurseOstomy Care
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy
No163WW0000XNursing Service ProvidersRegistered NurseWound Care