Healthcare Provider Details

I. General information

NPI: 1336700798
Provider Name (Legal Business Name): GWENDA K HATCHER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2019
Last Update Date: 03/22/2021
Certification Date: 03/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7525 E BROADWAY RD STE 2
MESA AZ
85208-1154
US

IV. Provider business mailing address

7525 E BROADWAY RD STE 2
MESA AZ
85208-1154
US

V. Phone/Fax

Practice location:
  • Phone: 480-981-9800
  • Fax: 480-930-4615
Mailing address:
  • Phone: 480-981-9800
  • Fax: 480-930-4615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number228154
License Number StateAZ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: