Provider Demographics
NPI:1932701794
Name:OXENDALE, GREGORY (RN)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:
Last Name:OXENDALE
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 1:9010 S PRIEST DR APT 1200
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85284-1077
Mailing Address - Country:US
Mailing Address - Phone:602-565-1090
Mailing Address - Fax:
Practice Address - Street 1:9010 S PRIEST DR APT 1200
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85284-1077
Practice Address - Country:US
Practice Address - Phone:602-565-1090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-16
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN190404163WA0400X, 163WP0808X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)
No163W00000XNursing Service ProvidersRegistered Nurse