Floyd Randel Gummersall, RN
Individual provider Active NPI Student in an Organized Health Care Education/Training Program · Bisbee, AZ
NPI 1699517896 · NPPES record last updated Jun 10, 2024
Key facts
- NPI
- 1699517896
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Student in an Organized Health Care Education/Training Program 390200000X
- Practice address
- 400 Headstart Way
Bisbee, AZ 85603-9764 - Phone
- (307) 371-4843
- Fax
- (307) 371-4843
- NPI assigned
- Jun 10, 2024
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Nurse
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | Yes |
Addresses
Primary practice location
400 Headstart Way
Bisbee, AZ 85603-9764
Mailing address
400 Headstart Way
Bisbee, AZ 85603-9764
Phone (307) 371-4843
Other providers in Bisbee, AZ
- Kathleen Gonzales
- Joseph John Graca
- Bianca Faith Gray
- Kathy Griesemer
- Linda Thresher Grimes
- Michael Harrington
- James Bruce Henrickson
- Phuong Mai Hoang
- Faye Chapman Hoese
- Gilberto Humar
All providers in Bisbee, AZ · Student in an Organized Health Care Education/Training Program in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 10, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.