1982855698 NPI number — MS. DOE DENISE GASQUE FNP-C

Table of content: MS. DOE DENISE GASQUE FNP-C (NPI 1982855698)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982855698 NPI number — MS. DOE DENISE GASQUE FNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GASQUE
Provider First Name:
DOE
Provider Middle Name:
DENISE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
FNP-C
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:
1982855698
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/28/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14758 HOPI RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
APPLE VALLEY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92307-3536
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-486-1492
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14758 HOPI RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
APPLE VALLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92307-3536
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-486-1492
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/01/2008

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: 363LF0000X , with the licence number:  R33733 , registered in the state of ND ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 002401 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".
  • Identifier: 556679 . This is a "CALIFORNIA BOARD OF NURSING" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: R33733 . This is a "ND NURSING" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
  • Identifier: 17731 . This is a "CALIFORNIA BOARD OF NURSING" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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