MEDICARE: MS. DEBBIE A GILSDORF

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	3747P1801X	Personal Care Attendant
2	374U00000X	Home Health Aide
3	376J00000X	Homemaker

General Provider Information

NPI Number	:	1851671846
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DEBBIE A GILSDORF

Provider Business Mailing Address
First Line	:	PO BOX 316
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86405-0316
Country	:	US
Telephone Number	:	928-566-1276
Fax Number	:

Provider Business Practice Location Address
First Line	:	3323 CANDLEWOOD PL
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86406-9069
Country	:	US
Telephone Number	:	928-566-1276
Fax Number	:

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

Provider Enumeration Date	:	08/22/2011
Last Update Date	:	08/22/2011

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Directions to “ MS. DEBBIE A GILSDORF ” Practice Location

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