Provider Demographics
NPI:1497744239
Name:GASAWAY, LUCY VALENTINE (MSN FNP)
Entity Type:Individual
Prefix:MRS
First Name:LUCY
Middle Name:VALENTINE
Last Name:GASAWAY
Suffix:
Gender:F
Credentials:MSN FNP
Other - Prefix:MS
Other - First Name:LUCY
Other - Middle Name:VALENTINE
Other - Last Name:MCCORMICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 160
Mailing Address - Street 2:
Mailing Address - City:SHIPROCK
Mailing Address - State:NM
Mailing Address - Zip Code:87420-0160
Mailing Address - Country:US
Mailing Address - Phone:505-368-6401
Mailing Address - Fax:505-368-6431
Practice Address - Street 1:US HWY 491 NORTH
Practice Address - Street 2:
Practice Address - City:SHIPROCK
Practice Address - State:NM
Practice Address - Zip Code:87420
Practice Address - Country:US
Practice Address - Phone:505-368-6401
Practice Address - Fax:505-368-6431
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN00000110583363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07110588Medicaid
NMS3794Medicaid
AZ697659Medicaid
320059Medicare Oscar/Certification
AZ697659Medicaid
CO07110588Medicaid
8HI692Medicare PIN