Provider Demographics
NPI:1053147660
Name:GASKINS, NIESHIA RENEE
Entity type:Individual
Prefix:MS
First Name:NIESHIA
Middle Name:RENEE
Last Name:GASKINS
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 1:4425 W OLIVE AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85302-3851
Mailing Address - Country:US
Mailing Address - Phone:623-755-9690
Mailing Address - Fax:623-264-3324
Practice Address - Street 1:4425 W OLIVE AVE STE 301
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85302-3851
Practice Address - Country:US
Practice Address - Phone:623-755-9690
Practice Address - Fax:623-264-3324
Is Sole Proprietor?:No
Enumeration Date:2024-09-10
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator