Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | RN034635 | AZ |
NPI | 1114909678 |
---|---|
Provider Name | Ms. Margaret E. Gatewood |
First Address | Phoenix, AZ 85010-5177 |
Second Address | Phoenix, AZ 85008-4973 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/11/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P30314 | (02) | AZ |