Healthcare Provider Details

I. General information

NPI: 1760721260
Provider Name (Legal Business Name): MARIE A DEISLER RN, MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2013
Last Update Date: 02/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1374 W FRONTAGE RD
RIO RICO AZ
85648-6377
US

IV. Provider business mailing address

1374 W FRONTAGE RD
RIO RICO AZ
85648-6377
US

V. Phone/Fax

Practice location:
  • Phone: 520-375-8308
  • Fax: 520-281-7973
Mailing address:
  • Phone: 520-375-8308
  • Fax: 520-281-7973

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN094347
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: