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General NPI Number Information
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NPI Number | 1346732112
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Entity Type | Individual
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Provider Name | PATRICIA ANN GASAWAY LPN
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Gender | Female
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Dates
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Enumeration Date | 06/06/2018
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Last Update Date | 06/06/2018
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Provider Practice Location Address
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Address Line | 524 W CENTRE AVE
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City | PORTAGE
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State | MI
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Zip | 49024-5306
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Country | US
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Telephone | 269-324-1180
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Fax |
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Provider Business Mailing Address
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Address Line | 8006 E W AVE
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City | VICKSBURG
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State | MI
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Zip | 49097-9202
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 4703043025
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License Number State | MI
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