Provider Demographics
NPI:1184156721
Name:GATES, CAROL E (RN)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:E
Last Name:GATES
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 1:1465 MAYFIELD CIR
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-6719
Mailing Address - Country:US
Mailing Address - Phone:303-588-1822
Mailing Address - Fax:
Practice Address - Street 1:1465 MAYFIELD CIR
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-6719
Practice Address - Country:US
Practice Address - Phone:303-588-1822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-02
Last Update Date:2017-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN.0054828163W00000X, 163WA2000X, 163WC0200X, 163WC0400X, 163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice