Provider Demographics
NPI:1962641266
Name:GIES, THERESA M (RN/CPNP)
Entity Type:Individual
Prefix:MS
First Name:THERESA
Middle Name:M
Last Name:GIES
Suffix:
Gender:F
Credentials:RN/CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9880 SOUTH MURRAY RIDGE ROAD
Mailing Address - Street 2:
Mailing Address - City:ELYRIA
Mailing Address - State:OH
Mailing Address - Zip Code:44035
Mailing Address - Country:US
Mailing Address - Phone:440-322-6367
Mailing Address - Fax:440-322-0911
Practice Address - Street 1:9880 SOUTH MURRAY RIDGE ROAD
Practice Address - Street 2:LORAIN COUNTY GENERAL HEALTH DISTRICT
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035
Practice Address - Country:US
Practice Address - Phone:440-322-6367
Practice Address - Fax:440-322-0911
Is Sole Proprietor?:No
Enumeration Date:2009-02-10
Last Update Date:2009-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN# 122838163W00000X
OHCNCP# NP02032363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2640379Medicaid