Provider Demographics
NPI:1639132764
Name:GATES, ANNIE M (CRNP)
Entity Type:Individual
Prefix:
First Name:ANNIE
Middle Name:M
Last Name:GATES
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:ANNIE
Other - Middle Name:SWARTZMAN
Other - Last Name:GATES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:1244 W CHESTER PIKE
Mailing Address - Street 2:SUITE 409
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19382-5657
Mailing Address - Country:US
Mailing Address - Phone:610-738-8016
Mailing Address - Fax:610-918-6316
Practice Address - Street 1:830 W CYPRESS ST
Practice Address - Street 2:
Practice Address - City:KENNETT SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19348-2218
Practice Address - Country:US
Practice Address - Phone:610-444-8084
Practice Address - Fax:610-918-6316
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAUP006229B363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
P03681Medicare UPIN
077523Medicare ID - Type Unspecified