Provider Demographics
NPI:1336575687
Name:GYURICZ, MARSHIA (RN)
Entity Type:Individual
Prefix:MRS
First Name:MARSHIA
Middle Name:
Last Name:GYURICZ
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 1:4100 LUCIA LN
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-3000
Mailing Address - Country:US
Mailing Address - Phone:505-471-4985
Mailing Address - Fax:505-471-6084
Practice Address - Street 1:4100 LUCIA LN
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-3000
Practice Address - Country:US
Practice Address - Phone:505-471-4985
Practice Address - Fax:505-471-6084
Is Sole Proprietor?:No
Enumeration Date:2013-09-18
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR62307163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM78172543Medicaid