Healthcare Provider Details

I. General information

NPI: 1982855698
Provider Name (Legal Business Name): DOE DENISE GASQUE FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2008
Last Update Date: 08/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14758 HOPI RD
APPLE VALLEY CA
92307-3536
US

IV. Provider business mailing address

14758 HOPI RD
APPLE VALLEY CA
92307-3536
US

V. Phone/Fax

Practice location:
  • Phone: 760-486-1492
  • Fax:
Mailing address:
  • Phone: 760-486-1492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR33733
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: