Provider Demographics
NPI:1215791629
Name:GATEWOOD, SANDRA DENISE
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:DENISE
Last Name:GATEWOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22020 WESTHAMPTON ST
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-2770
Mailing Address - Country:US
Mailing Address - Phone:313-739-7370
Mailing Address - Fax:
Practice Address - Street 1:115 ERSKINE ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2776
Practice Address - Country:US
Practice Address - Phone:313-739-7370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-07
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker