Provider Demographics
NPI:1194791095
Name:GUBITOSO, MARY JO (ARNP)
Entity type:Individual
Prefix:
First Name:MARY JO
Middle Name:
Last Name:GUBITOSO
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2214 CANTERBURY DR
Mailing Address - Street 2:SUITE 302
Mailing Address - City:HAYS
Mailing Address - State:KS
Mailing Address - Zip Code:67601-2375
Mailing Address - Country:US
Mailing Address - Phone:785-623-4699
Mailing Address - Fax:785-623-4816
Practice Address - Street 1:2214 CANTERBURY DR
Practice Address - Street 2:SUITE 302
Practice Address - City:HAYS
Practice Address - State:KS
Practice Address - Zip Code:67601-2375
Practice Address - Country:US
Practice Address - Phone:785-623-4699
Practice Address - Fax:785-623-4816
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS45220363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSP39838Medicare UPIN
KS160814Medicare ID - Type UnspecifiedINDIVIDUAL MEDICARE #