Provider Demographics
NPI:1558837260
Name:WALES, GINA MICHELLE (RN)
Entity Type:Individual
Prefix:MRS
First Name:GINA
Middle Name:MICHELLE
Last Name:WALES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3555 E FRY BLVD
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-2972
Mailing Address - Country:US
Mailing Address - Phone:520-515-2990
Mailing Address - Fax:520-515-2994
Practice Address - Street 1:3555 E FRY BLVD
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-2972
Practice Address - Country:US
Practice Address - Phone:520-515-2990
Practice Address - Fax:520-515-2994
Is Sole Proprietor?:No
Enumeration Date:2018-10-19
Last Update Date:2018-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN162394163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool