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General NPI Number Information
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NPI Number | 1407073562
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Entity Type | Individual
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Provider Name | SHELLEY D GATES NP
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Gender | Female
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Dates
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Enumeration Date | 04/19/2007
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Last Update Date | 12/11/2017
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Provider Practice Location Address
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Address Line | 2345 W FRANKLIN ST STE 201
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City | EVANSVILLE
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State | IN
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Zip | 47712-5100
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Country | US
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Telephone | 812-401-0500
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 13059
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City | BELFAST
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State | ME
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Zip | 04915-4021
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 71000461A
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License Number State | IN
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