Provider Demographics
NPI:1598514986
Name:GATSIMBANYI, MARIE PAUL
Entity type:Individual
Prefix:
First Name:MARIE PAUL
Middle Name:
Last Name:GATSIMBANYI
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 1:2228 W NORTHERN AVE STE B210
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-9336
Mailing Address - Country:US
Mailing Address - Phone:480-444-7447
Mailing Address - Fax:
Practice Address - Street 1:2228 W NORTHERN AVE STE B210
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-9336
Practice Address - Country:US
Practice Address - Phone:480-444-7447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-16
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ307411363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily