Provider Demographics
NPI:1306453220
Name:BIRK, MARILIZABETH (PMHNP-BC, RN, BA)
Entity type:Individual
Prefix:
First Name:MARILIZABETH
Middle Name:
Last Name:BIRK
Suffix:
Gender:F
Credentials:PMHNP-BC, RN, BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16042 N 32ND ST STE A2
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-0024
Mailing Address - Country:US
Mailing Address - Phone:480-300-4761
Mailing Address - Fax:780-903-1607
Practice Address - Street 1:3864 N 27TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85017-4703
Practice Address - Country:US
Practice Address - Phone:602-797-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-24
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ236418163WS0200X, 363LP0808X, 2084P0804X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No163WS0200XNursing Service ProvidersRegistered NurseSchool
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty