Provider Demographics
NPI:1255681896
Name:GIESEN, TINA (LMT)
Entity Type:Individual
Prefix:MRS
First Name:TINA
Middle Name:
Last Name:GIESEN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 WARRENVILLE RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60189-6379
Mailing Address - Country:US
Mailing Address - Phone:630-605-5452
Mailing Address - Fax:
Practice Address - Street 1:705 WARRENVILLE RD
Practice Address - Street 2:SUITE D
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60189-6379
Practice Address - Country:US
Practice Address - Phone:630-605-5452
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-11
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula