Healthcare Provider Details

I. General information

NPI: 1922025907
Provider Name (Legal Business Name): ANU G GABA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 02/14/2021
Certification Date: 02/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 4TH ST N
FARGO ND
58122-0001
US

IV. Provider business mailing address

820 4TH ST N
FARGO ND
58122-0001
US

V. Phone/Fax

Practice location:
  • Phone: 701-234-6161
  • Fax: 701-234-7257
Mailing address:
  • Phone: 701-234-6161
  • Fax: 701-234-7257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number9598
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number47654
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: