Provider Demographics
NPI:1033109574
Name:NEILL, GERTRUDE F (CRNA)
Entity Type:Individual
Prefix:
First Name:GERTRUDE
Middle Name:F
Last Name:NEILL
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6906 E EXETER BLVD
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-2330
Mailing Address - Country:US
Mailing Address - Phone:239-000-0000
Mailing Address - Fax:
Practice Address - Street 1:6906 E EXETER BLVD
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-2330
Practice Address - Country:US
Practice Address - Phone:239-000-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9184251367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL430070446OtherMCRR
FL304190500Medicaid
FLG2986ZOtherMCR
FLG2986OtherBSFL