Provider Demographics
NPI:1528840212
Name:GEVSHANYAN, MARYANN (MSN, APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:MARYANN
Middle Name:
Last Name:GEVSHANYAN
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1071 E ANGELENO AVE
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91501-1420
Mailing Address - Country:US
Mailing Address - Phone:818-720-8884
Mailing Address - Fax:818-478-1827
Practice Address - Street 1:303 N GLENOAKS BLVD # 233
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91502-1116
Practice Address - Country:US
Practice Address - Phone:818-748-3042
Practice Address - Fax:818-748-3043
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-17
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95027713363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily