Provider Demographics
NPI:1790424919
Name:GIAUQUE, MARIAN (APRN)
Entity Type:Individual
Prefix:
First Name:MARIAN
Middle Name:
Last Name:GIAUQUE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:428 E 2260 N
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-1729
Mailing Address - Country:US
Mailing Address - Phone:801-830-0953
Mailing Address - Fax:
Practice Address - Street 1:1159 E 200 N STE 200
Practice Address - Street 2:
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-2026
Practice Address - Country:US
Practice Address - Phone:801-756-5209
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-04
Last Update Date:2022-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5423213-4405363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics