Provider Demographics
NPI:1003522087
Name:KNYSHEVA, MARINA
Entity type:Individual
Prefix:
First Name:MARINA
Middle Name:
Last Name:KNYSHEVA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:482 E WINDY GARDEN LN
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-5542
Mailing Address - Country:US
Mailing Address - Phone:801-706-8447
Mailing Address - Fax:
Practice Address - Street 1:1959 NE PACIFIC STREET BOX 356421
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195-5888
Practice Address - Country:US
Practice Address - Phone:206-543-3605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-24
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program