Provider Demographics
NPI:1346091188
Name:GAIDAMAVICIUS, MARGARET
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:
Last Name:GAIDAMAVICIUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9558 W GAMBIT TRL
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-8724
Mailing Address - Country:US
Mailing Address - Phone:630-301-4770
Mailing Address - Fax:
Practice Address - Street 1:585 N JUNIPER DR STE 200
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226-2559
Practice Address - Country:US
Practice Address - Phone:480-499-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-29
Last Update Date:2025-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.029356363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care