Provider Demographics
NPI:1952645673
Name:GIVAN PETRISHIN, MONICA MARIE (RN)
Entity Type:Individual
Prefix:MS
First Name:MONICA
Middle Name:MARIE
Last Name:GIVAN PETRISHIN
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 1:211 COUNCIL ST
Mailing Address - Street 2:
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14304-4419
Mailing Address - Country:US
Mailing Address - Phone:716-286-7909
Mailing Address - Fax:
Practice Address - Street 1:4455 PORTER RD
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14305-3309
Practice Address - Country:US
Practice Address - Phone:716-286-7909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-19
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY477994163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse