MEDICARE: MARIE PAUL GATSIMBANYI

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	307411	AZ

General Provider Information

NPI Number	:	1598514986
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIE PAUL GATSIMBANYI

Provider Business Mailing Address
First Line	:	2228 W NORTHERN AVE STE B210
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85021-9336
Country	:	US
Telephone Number	:	480-444-7447
Fax Number	:

Provider Business Practice Location Address
First Line	:	2228 W NORTHERN AVE STE B210
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85021-9336
Country	:	US
Telephone Number	:	480-444-7447
Fax Number	:

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

Provider Enumeration Date	:	05/16/2024
Last Update Date	:	05/16/2024

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