MEDICARE: MARIAN GIACONA

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	163WD0400X	Diabetes Educator Registered Nurse	4704106951	MI

General Provider Information

NPI Number	:	1144723255
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIAN GIACONA

Provider Business Mailing Address
First Line	:	43421 GARFIELD RD STE 203
Second Line	:
City	:	CLINTON TOWNSHIP
State	:	MI
Zip	:	48038-1133
Country	:	US
Telephone Number	:	586-263-2116
Fax Number	:

Provider Business Practice Location Address
First Line	:	43421 GARFIELD RD STE 203
Second Line	:
City	:	CLINTON TOWNSHIP
State	:	MI
Zip	:	48038-1133
Country	:	US
Telephone Number	:	586-263-2116
Fax Number	:

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

Provider Enumeration Date	:	03/14/2018
Last Update Date	:	03/14/2018

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