Provider Demographics
NPI:1902993389
Name:GANEM, MARINA (CNM)
Entity Type:Individual
Prefix:
First Name:MARINA
Middle Name:
Last Name:GANEM
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 31235
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85751-1235
Mailing Address - Country:US
Mailing Address - Phone:520-324-4100
Mailing Address - Fax:520-324-1406
Practice Address - Street 1:5301 E GRANT RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2805
Practice Address - Country:US
Practice Address - Phone:520-795-8188
Practice Address - Fax:520-325-0809
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZRN063655367A00000X
AZAP6862367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ385676Medicaid
AZAP6862OtherAMERICAN ACADEMY OF NURSE PRACTITIONERS
AZ385676Medicaid