Provider Demographics
NPI:1407302300
Name:SILVEIRA, GINA (NP)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:SILVEIRA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:LEE
Other - Last Name:WADE/HAUGEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 3630
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86003-3630
Mailing Address - Country:US
Mailing Address - Phone:928-537-4300
Mailing Address - Fax:
Practice Address - Street 1:2650 E SHOW LOW LAKE RD STE 1
Practice Address - Street 2:
Practice Address - City:SHOW LOW
Practice Address - State:AZ
Practice Address - Zip Code:85901-7955
Practice Address - Country:US
Practice Address - Phone:928-537-4300
Practice Address - Fax:928-537-4320
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-30
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95004773363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner