Provider Demographics
NPI:1205461811
Name:GEERTZ, MARIKA ROSE (APRN)
Entity type:Individual
Prefix:
First Name:MARIKA
Middle Name:ROSE
Last Name:GEERTZ
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 1:2619 CAREY ST
Mailing Address - Street 2:
Mailing Address - City:CODY
Mailing Address - State:WY
Mailing Address - Zip Code:82414-9449
Mailing Address - Country:US
Mailing Address - Phone:307-272-0507
Mailing Address - Fax:
Practice Address - Street 1:2619 CAREY ST
Practice Address - Street 2:
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414-9449
Practice Address - Country:US
Practice Address - Phone:307-272-0507
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-04
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY48367363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health