Basic Information
Provider Information
NPI: 1811431612
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GAFFNEY
FirstName: EMILY
MiddleName:  
NamePrefix: MRS.
NameSuffix:  
Credential: FNP-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 860
Address2:  
City: WHITERIVER
State: AZ
PostalCode: 859410860
CountryCode: US
TelephoneNumber: 9283384911
FaxNumber:  
Practice Location
Address1: 200 WEST HOSPITAL DRIVE
Address2:  
City: WHITERIVER
State: AZ
PostalCode: 85941
CountryCode: US
TelephoneNumber: 9283384911
FaxNumber:  
Other Information
ProviderEnumerationDate: 12/13/2016
LastUpdateDate: 12/13/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000XAP9716AZY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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