Provider Demographics
NPI:1669951729
Name:GUANSO, MARIVIC BADILLA (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:MARIVIC
Middle Name:BADILLA
Last Name:GUANSO
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6820 E BROWN RD
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85207-3705
Mailing Address - Country:US
Mailing Address - Phone:480-718-1285
Mailing Address - Fax:
Practice Address - Street 1:6820 E BROWN RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85207
Practice Address - Country:US
Practice Address - Phone:480-718-1285
Practice Address - Fax:602-830-6014
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-09
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP11495363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily