Provider Demographics
NPI:1386837482
Name:GORBACHINSKY, MARINA (ANP)
Entity Type:Individual
Prefix:MRS
First Name:MARINA
Middle Name:
Last Name:GORBACHINSKY
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 GOLDENSPUR LN
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-1377
Mailing Address - Country:US
Mailing Address - Phone:412-877-1786
Mailing Address - Fax:702-982-5148
Practice Address - Street 1:4755 W ANN RD
Practice Address - Street 2:SUITE 400
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89031-3424
Practice Address - Country:US
Practice Address - Phone:720-645-0332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-22
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPN000963363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV105582Medicare UPIN