1790722262 NPI number — MS. DELORES H GASKIN CRNA

Table of content: MS. DELORES H GASKIN CRNA (NPI 1790722262)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790722262 NPI number — MS. DELORES H GASKIN CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GASKIN
Provider First Name:
DELORES
Provider Middle Name:
H
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1790722262
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5615
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRESNO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93755-5615
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
559-436-1000
Provider Business Mailing Address Fax Number:
559-354-4235

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2825 RANDOLPH RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28211-1075
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-377-1647
Provider Business Practice Location Address Fax Number:
704-358-8267
Provider Enumeration Date:
06/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  034594 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 8050169 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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