Healthcare Provider Details

I. General information

NPI: 1306453220
Provider Name (Legal Business Name): MARILIZABETH BIRK PMHNP-BC, RN, BA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2020
Last Update Date: 05/02/2025
Certification Date: 05/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3864 N 27TH AVE
PHOENIX AZ
85017-4703
US

IV. Provider business mailing address

16042 N 32ND ST STE A2
PHOENIX AZ
85032-0024
US

V. Phone/Fax

Practice location:
  • Phone: 602-797-7000
  • Fax:
Mailing address:
  • Phone: 480-300-4761
  • Fax: 780-903-1607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number236418
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number236418
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: