Basic Information
| Provider Information | |||||||||
| NPI: | 1417201260 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GIERSZ | ||||||||
| FirstName: | THERESA | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5091 ANDRUS AVE | ||||||||
| Address2: | |||||||||
| City: | NORTH OLMSTED | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440704302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3308885436 | ||||||||
| FaxNumber: | 3306708569 | ||||||||
| Practice Location | |||||||||
| Address1: | 4807 ROCKSIDE ROAD | ||||||||
| Address2: | STE 110 | ||||||||
| City: | INDEPENDENCE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 44131 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2165200765 | ||||||||
| FaxNumber: | 2165201427 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2012 | ||||||||
| LastUpdateDate: | 04/04/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | 13646-NP | OH | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | 363LA2200X | COA13646NP | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No ID Information.