Provider Demographics
NPI:1700228186
Name:MCGINNIS, MARIAH LEA (RN)
Entity Type:Individual
Prefix:MRS
First Name:MARIAH
Middle Name:LEA
Last Name:MCGINNIS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7308 SW 12TH ST
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50315-6603
Mailing Address - Country:US
Mailing Address - Phone:515-419-1729
Mailing Address - Fax:
Practice Address - Street 1:7308 SW 12TH ST
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50315-6603
Practice Address - Country:US
Practice Address - Phone:515-419-1729
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-25
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA123345163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse