Provider Demographics
NPI:1144525080
Name:GADDIE, DENICE MAYLENE (ACUPUNCTURIST)
Entity type:Individual
Prefix:MS
First Name:DENICE
Middle Name:MAYLENE
Last Name:GADDIE
Suffix:
Gender:F
Credentials:ACUPUNCTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 671
Mailing Address - Street 2:
Mailing Address - City:NACO
Mailing Address - State:AZ
Mailing Address - Zip Code:85620-0671
Mailing Address - Country:US
Mailing Address - Phone:520-366-1137
Mailing Address - Fax:
Practice Address - Street 1:125 BISBEE RD.
Practice Address - Street 2:
Practice Address - City:BISBEE
Practice Address - State:AZ
Practice Address - Zip Code:85603
Practice Address - Country:US
Practice Address - Phone:520-366-1137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-25
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0417171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist