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General NPI Number Information
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NPI Number | 1104609932
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Entity Type | Organization
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Legal Business Name | VIRTUALMED PLLC
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Dates
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Enumeration Date | 08/15/2023
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Last Update Date | 09/17/2024
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Provider Practice Location Address
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Address Line | 4140 E BASELINE RD STE 101
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City | MESA
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State | AZ
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Zip | 85206-4413
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Country | US
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Telephone | 480-603-8859
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 51504
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City | MESA
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State | AZ
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Zip | 85208-0076
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Country | US
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Telephone | 480-603-8859
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MIANNA GALE
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Credential | PMHNP-BC
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Telephone | 480-603-8859
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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