Basic Information
Provider Information
NPI: 1568010312
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SCHWIRBLAT
FirstName: GIANVIEVE
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 670 9TH ST STE 203
Address2:  
City: ARCATA
State: CA
PostalCode: 955216249
CountryCode: US
TelephoneNumber: 7078268633
FaxNumber: 7078268638
Practice Location
Address1: 2200 TYDD ST
Address2:  
City: EUREKA
State: CA
PostalCode: 955011284
CountryCode: US
TelephoneNumber: 7074411624
FaxNumber: 7074411253
Other Information
ProviderEnumerationDate: 08/26/2019
LastUpdateDate: 03/24/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 03/24/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163W00000X95156548CAN Nursing Service ProvidersRegistered Nurse 
363LF0000X95013417CAY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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