Provider Demographics
NPI:1114949260
Name:GATES, JANICE RUTH (APN)
Entity Type:Individual
Prefix:MRS
First Name:JANICE
Middle Name:RUTH
Last Name:GATES
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 OLD CONFEDERATE DR
Mailing Address - Street 2:
Mailing Address - City:DE QUEEN
Mailing Address - State:AR
Mailing Address - Zip Code:71832-8426
Mailing Address - Country:US
Mailing Address - Phone:870-642-2535
Mailing Address - Fax:870-642-5229
Practice Address - Street 1:104 OLD CONFEDERATE DR
Practice Address - Street 2:
Practice Address - City:DE QUEEN
Practice Address - State:AR
Practice Address - Zip Code:71832-8426
Practice Address - Country:US
Practice Address - Phone:870-642-2535
Practice Address - Fax:870-642-5229
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR169787163WW0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory