Provider Demographics
NPI:1770814915
Name:GAVI, ROGER LOUIS (RN)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:LOUIS
Last Name:GAVI
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3604 CAMEO DR SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87105-0204
Mailing Address - Country:US
Mailing Address - Phone:505-340-1171
Mailing Address - Fax:
Practice Address - Street 1:3604 CAMEO DR SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87105-0204
Practice Address - Country:US
Practice Address - Phone:505-340-1171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-28
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR59159163WG0600X, 163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0600XNursing Service ProvidersRegistered NurseGerontology
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult