1407062334 NPI number — MARCELLE RUTH HANISH NP

Table of content: MARCELLE RUTH HANISH NP (NPI 1407062334)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407062334 NPI number — MARCELLE RUTH HANISH NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HANISH
Provider First Name:
MARCELLE
Provider Middle Name:
RUTH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HANISH
Provider Other First Name:
MARCELLE
Provider Other Middle Name:
R
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
NP
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1407062334
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/21/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9736 N 95TH ST UNIT 126
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SCOTTSDALE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85258-9175
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-881-8189
Provider Business Mailing Address Fax Number:
480-315-6528

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8149 N 87TH PL STE 134
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SCOTTSDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85258-4399
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-881-8189
Provider Business Practice Location Address Fax Number:
480-315-6528
Provider Enumeration Date:
05/15/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  AP9001 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)