=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699532465
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HEATHER GIERISH APRN-RNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/28/2024
-----------------------------------------------------
Last Update Date | 08/05/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15351 W BELL RD
-----------------------------------------------------
City | SURPRISE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85374-4580
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-964-2273
-----------------------------------------------------
Fax | 623-440-1485
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10065 W PATRICK LN
-----------------------------------------------------
City | PEORIA
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85383-2891
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-448-4279
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | 304525
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------