Provider Demographics
NPI:1649572389
Name:MCLEOD, GEMIE MAE (NMD)
Entity type:Individual
Prefix:DR
First Name:GEMIE
Middle Name:MAE
Last Name:MCLEOD
Suffix:
Gender:F
Credentials:NMD
Other - Prefix:DR
Other - First Name:GEMIE
Other - Middle Name:MAE
Other - Last Name:KOHLER MCLEOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NMD
Mailing Address - Street 1:2001 EXCELLENCE WAY STE 100
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-8411
Mailing Address - Country:US
Mailing Address - Phone:928-776-1600
Mailing Address - Fax:928-778-5264
Practice Address - Street 1:2001 EXCELLENCE WAY STE 100
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-8411
Practice Address - Country:US
Practice Address - Phone:928-776-1600
Practice Address - Fax:928-778-5264
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-01
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10-1215175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath