Provider Demographics
NPI:1962671750
Name:GAMMETT, PATRICIA L
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:L
Last Name:GAMMETT
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 1:7323 DEER FLAT RD
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83686-9453
Mailing Address - Country:US
Mailing Address - Phone:208-467-2143
Mailing Address - Fax:
Practice Address - Street 1:7323 DEER FLAT RD
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83686-9453
Practice Address - Country:US
Practice Address - Phone:208-467-2143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-26
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDBA167996I347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle