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NPI Code Detail

MEDICARE: MARINA GJELEVIQ

MEDICARE: MARINA GJELEVIQ
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1367500000XCertified Registered Nurse AnesthetistNAMI

General Provider Information

NPI Number : 1417705062
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARINA GJELEVIQ
Provider Business Mailing Address
First Line : 63615 GEORGETOWNE W
Second Line :
City : WASHINGTON
State : MI
Zip : 48095-2436
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 303 E KEARSLEY ST
Second Line :
City : FLINT
State : MI
Zip : 48502-1907
Country : US
Telephone Number : 586-819-9456
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/08/2024
Last Update Date : 12/07/2025

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Directions to “ MARINA GJELEVIQ ” Practice Location

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