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General NPI Number Information
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NPI Number | 1225240542
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Entity Type | Organization
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Legal Business Name | GAZZA LAB NEUROLOGY, PSC
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Dates
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Enumeration Date | 05/07/2007
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Last Update Date | 05/05/2008
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Provider Practice Location Address
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Address Line | 1830 HIGH ST SUITE A
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City | HOPKINSVILLE
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State | KY
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Zip | 42240-1746
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Country | US
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Telephone | 270-886-2559
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Fax | 270-886-0388
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Provider Business Mailing Address
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Address Line | 1830 HIGH ST SUITE A
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City | HOPKINSVILLE
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State | KY
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Zip | 42240-1746
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Country | US
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Telephone | 270-886-2559
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Fax | 270-886-0388
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Authorized Official
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Title or Position | DIRECTOR
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Name | WENDY U. NAIMOLI
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Credential |
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Telephone | 270-886-2559
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | KY30882
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License Number State | KY
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