Provider Demographics
NPI:1720741721
Name:GETHERS, MARITA (PNP)
Entity Type:Individual
Prefix:
First Name:MARITA
Middle Name:
Last Name:GETHERS
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 SCOTT RD APT 203
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91504-3867
Mailing Address - Country:US
Mailing Address - Phone:301-466-8306
Mailing Address - Fax:
Practice Address - Street 1:1720 SCOTT RD APT 203
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91504-3867
Practice Address - Country:US
Practice Address - Phone:301-466-8306
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-16
Last Update Date:2021-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95016198363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Single Specialty