Provider Demographics
NPI:1588108633
Name:DR. NLGD, LLC
Entity type:Organization
Organization Name:DR. NLGD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DNP
Authorized Official - Prefix:DR
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:GAINES-DILLARD
Authorized Official - Suffix:
Authorized Official - Credentials:DNP-APRN-BC
Authorized Official - Phone:480-669-6452
Mailing Address - Street 1:2487 S GILBERT RD STE 106-502
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-2832
Mailing Address - Country:US
Mailing Address - Phone:480-669-6452
Mailing Address - Fax:888-977-3601
Practice Address - Street 1:2487 S GILBERT RD STE 106-502
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-2832
Practice Address - Country:US
Practice Address - Phone:480-669-6452
Practice Address - Fax:888-977-3601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-08
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP8274363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty