MEDICARE: MRS. TERESA MARIE GAITHER FNP

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	363LF0000X	Family Nurse Practitioner	AP8166	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AP61336652	OTHER	WA	LICENSE
2	APRN11020482	OTHER	FL	LICENSE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	68527	OTHER	ID	LICENSE
5	APN0002960	OTHER	CO	LICENSE
6	APRN-CNP934913	OTHER	NV	LICENSE
7	F0915793	OTHER		BOARD
8	1023833	OTHER	TX	LICENSE
9	AP8166	OTHER	AZ	LICENSE
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568835890
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TERESA MARIE GAITHER FNP

Provider Business Mailing Address
First Line	:	3083 S COTTONWOOD CT
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85286-2384
Country	:	US
Telephone Number	:	480-712-8319
Fax Number	:	480-712-1305

Provider Business Practice Location Address
First Line	:	16515 S. 40TH ST, BLDG 9, SUITE 143
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85048-0560
Country	:	US
Telephone Number	:	480-712-8319
Fax Number	:	480-712-1305

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

Provider Enumeration Date	:	11/09/2015
Last Update Date	:	11/03/2022

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