Provider Demographics
NPI:1316413040
Name:GATICA-HAYNES, MARCELA (RN)
Entity Type:Individual
Prefix:
First Name:MARCELA
Middle Name:
Last Name:GATICA-HAYNES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:MARCELA
Other - Middle Name:
Other - Last Name:GATICA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:2803 N SANDSTONE WAY
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86004-7633
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2803 N SANDSTONE WAY
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86004-7633
Practice Address - Country:US
Practice Address - Phone:773-209-7502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-20
Last Update Date:2018-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN178168163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency