Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | AP4051 | AZ |
NPI | 1144513904 |
---|---|
Provider Name | Shelby Marie Gattis |
First Address | Surprise, AZ 85374-5746 |
Second Address | Glendale, AZ 85306-4622 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2011 |
Last Update Date | 23/08/2011 |