Doctor Name: | MRS. ALICE ADELLA GAUNT |
NPI Number: | 1598834053 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | RN, FNP |
License Number: | 85408 |
Business Practice Address: | 1180 Broadway St King City, CA - 939303602 |
Business Phone Number: | 8313850922 |
Business Fax Number: | 8313859170 |
Mailing Address: | 1180 Broadway St, KING CITY |
State: | CA |
Postal Code: | 939303602 |
Phone Number: | 8313850922 |
Fax Number: | 8313859170 |
NPI Enumeration Date: | 11/07/2006 |
NPI Last Update Date: | 12/18/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 85408 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |