Provider Demographics
NPI:1952732380
Name:AGUIRRE KAIAMA, GLENDA LAGAZO (FNP)
Entity Type:Individual
Prefix:MS
First Name:GLENDA
Middle Name:LAGAZO
Last Name:AGUIRRE KAIAMA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 E RIVULON BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297-0087
Mailing Address - Country:US
Mailing Address - Phone:480-494-2465
Mailing Address - Fax:
Practice Address - Street 1:161 E RIVULON BLVD STE 210
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-0087
Practice Address - Country:US
Practice Address - Phone:480-494-2465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-11
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP5334363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily