MEDICARE: KIERAN AMBRY MARIA GESKO ND

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
1	175F00000X	Naturopath

General Provider Information

NPI Number	:	1043931256
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIERAN AMBRY MARIA GESKO ND

Provider Business Mailing Address
First Line	:	1961 N HARTFORD ST UNIT 1204
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85225-7310
Country	:	US
Telephone Number	:	206-941-2422
Fax Number	:

Provider Business Practice Location Address
First Line	:	1961 N HARTFORD ST UNIT 1204
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85225-7310
Country	:	US
Telephone Number	:	206-941-2422
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/06/2022
Last Update Date	:	09/06/2022

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