Healthcare Provider Details

I. General information

NPI: 1134280175
Provider Name (Legal Business Name): TWILA IONE GOTTLIEB RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6915 E GUADALUPE RD
MESA AZ
85212-1752
US

IV. Provider business mailing address

4337 E DESERT LN
HIGLEY AZ
85236-3132
US

V. Phone/Fax

Practice location:
  • Phone: 480-632-4739
  • Fax: 480-632-4729
Mailing address:
  • Phone: 480-218-5009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN052210
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: