MEDICARE: JULIET MAKENA GATOBU APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	5378364082	KS
2	363LG0600X	Gerontology Nurse Practitioner	78364	KS
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP138627	TX
4	363LG0600X	Gerontology Nurse Practitioner	64600	TX

General Provider Information

NPI Number	:	1245711050
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIET MAKENA GATOBU APRN

Provider Business Mailing Address
First Line	:	8101 ROUGHRIDER DR
Second Line	:
City	:	WINDCREST
State	:	TX
Zip	:	78239-2428
Country	:	US
Telephone Number	:	210-657-3700
Fax Number	:	210-657-3708

Provider Business Practice Location Address
First Line	:	8101 ROUGHRIDER DR
Second Line	:
City	:	WINDCREST
State	:	TX
Zip	:	78239-2428
Country	:	US
Telephone Number	:	210-657-3700
Fax Number	:	210-657-3708

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/29/2018
Last Update Date	:	10/20/2022

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