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General NPI Number Information
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NPI Number | 1659957892
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Entity Type | Individual
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Provider Name | ELIZABETH GATES CRNP
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Gender | Female
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Dates
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Enumeration Date | 03/18/2021
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Last Update Date | 03/18/2021
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Provider Practice Location Address
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Address Line | 4704 WHITESBURG DR SW STE 201
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City | HUNTSVILLE
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State | AL
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Zip | 35802-1681
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Country | US
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Telephone | 256-489-5215
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Fax |
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Provider Business Mailing Address
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Address Line | 2245 GREEN BRIAR COVE RD
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City | UNION GROVE
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State | AL
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Zip | 35175-8362
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Country | US
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Telephone | 256-509-1423
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 1-166147
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License Number State | AL
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