Healthcare Provider Details

I. General information

NPI: 1568835890
Provider Name (Legal Business Name): TERESA MARIE GAITHER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2015
Last Update Date: 11/03/2022
Certification Date: 10/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16515 S. 40TH ST, BLDG 9, SUITE 143
PHOENIX AZ
85048-0560
US

IV. Provider business mailing address

3083 S COTTONWOOD CT
CHANDLER AZ
85286-2384
US

V. Phone/Fax

Practice location:
  • Phone: 480-712-8319
  • Fax: 480-712-1305
Mailing address:
  • Phone: 480-712-8319
  • Fax: 480-712-1305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP8166
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: