Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 71000457A | IN |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 71000457A | IN |
N | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 71000457A | IN |
NPI | 1023051141 |
---|---|
Provider Name | Roseanna L Parkhurst Gatewood |
First Address | Belfast, ME 04915-4021 |
Second Address | Evansville, IN 47714 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2006 |
Last Update Date | 12/07/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000311142 | ANTHEM PIN (01) | IN |
000000488130 | ANTHEM PIN (01) | IN |
000000557880 | ANTHEM PIN (01) | IN |
200322860 | (05) | IN |
200829650G | MEDICAID GROUP (01) | IN |
200859330J | MEDICAID GROUP (01) | IN |
237890 | MEDICARE GROUP (01) | IN |
250470S | MEDICARE GROUP (01) | IN |
78005964 | (05) | KY |
DF3251 | RAILROAD GROUP (01) | IN |
P00362819 | RAILROAD INDIVIDUAL (01) | IN |
P20113 | (02) | IN |