Garrett Vanderwater

Primary specialty

Emergency Registered NurseTaxonomy code 163WE0003X

License

1645507 Issued in CO

Practice address

1808 W Aztec Ave
Gallup, NM 87301-6780

Phone

(505) 722-1000

NPI assigned

Nov 3, 2020

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1604361600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604361600000",
    "number": "1720689136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "516 E NIZHONI BLVD",
            "city": "GALLUP",
            "state": "NM",
            "postal_code": "873015748"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1808 W AZTEC AVE",
            "city": "GALLUP",
            "state": "NM",
            "postal_code": "873016780",
            "telephone_number": "505-722-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANDERWATER",
        "first_name": "GARRETT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-11-03",
        "last_updated": "2020-11-03",
        "certification_date": "2020-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WE0003X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Emergency",
            "state": "CO",
            "license": "1645507",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joshua David Valgardson, PHARMD
• Henry Valmana
• Linda Van Asselt-King, CNM
• David J Vance, RN
• Dan Vanderiet, M.D.
• Flora Vandever
• Jerilene Marie Vann, RN
• Charlene Vansant, RN
• Kathleen M. Varty, CNM
• Anjelika Vasquez, M.A.

• Emergency Registered Nurse in Gallup, NM
• Providers in Gallup, NM by specialty
• Emergency Registered Nurse in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.