MEDICARE: MARCELA GATICA-HAYNES RN

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	163WE0003X	Emergency Registered Nurse	RN178168	AZ

General Provider Information

NPI Number	:	1316413040
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARCELA GATICA-HAYNES RN

Provider Business Mailing Address
First Line	:	2803 N SANDSTONE WAY
Second Line	:
City	:	FLAGSTAFF
State	:	AZ
Zip	:	86004-7633
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2803 N SANDSTONE WAY
Second Line	:
City	:	FLAGSTAFF
State	:	AZ
Zip	:	86004-7633
Country	:	US
Telephone Number	:	773-209-7502
Fax Number	:

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

Provider Enumeration Date	:	10/20/2018
Last Update Date	:	10/20/2018

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