Provider Demographics
NPI:1407062334
Name:HANISH, MARCELLE RUTH (NP)
Entity Type:Individual
Prefix:
First Name:MARCELLE
Middle Name:RUTH
Last Name:HANISH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MARCELLE
Other - Middle Name:R
Other - Last Name:HANISH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:9736 N 95TH ST UNIT 126
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-9175
Mailing Address - Country:US
Mailing Address - Phone:602-881-8189
Mailing Address - Fax:480-315-6528
Practice Address - Street 1:8149 N 87TH PL STE 134
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4399
Practice Address - Country:US
Practice Address - Phone:602-881-8189
Practice Address - Fax:480-315-6528
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP9001363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily