Provider Demographics
NPI:1134280175
Name:GOTTLIEB, TWILA IONE (RN)
Entity type:Individual
Prefix:MRS
First Name:TWILA
Middle Name:IONE
Last Name:GOTTLIEB
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 1:4337 E DESERT LN
Mailing Address - Street 2:
Mailing Address - City:HIGLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85236-3132
Mailing Address - Country:US
Mailing Address - Phone:480-218-5009
Mailing Address - Fax:
Practice Address - Street 1:6915 E GUADALUPE RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85212-1752
Practice Address - Country:US
Practice Address - Phone:480-632-4739
Practice Address - Fax:480-632-4729
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN052210163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool