Provider Demographics
NPI:1790540474
Name:GATER, DAIZJA
Entity type:Individual
Prefix:
First Name:DAIZJA
Middle Name:
Last Name:GATER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:778 TOULOUSE
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49017-3200
Mailing Address - Country:US
Mailing Address - Phone:313-717-2970
Mailing Address - Fax:
Practice Address - Street 1:778 TOULOUSE
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49017-3200
Practice Address - Country:US
Practice Address - Phone:313-717-2970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-20
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive CareGroup - Single Specialty