1205806221 NPI number — MS. GAIL BOWERS SHERIDAN F.N.P.

Table of content: DANIELLE LEBLANC (NPI 1376378547)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205806221 NPI number — MS. GAIL BOWERS SHERIDAN F.N.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHERIDAN
Provider First Name:
GAIL
Provider Middle Name:
BOWERS
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
F.N.P.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205806221
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/11/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9003 AIRPORT FWY
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
NORTH RICHLAND HILLS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76180-7770
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-514-5200
Provider Business Mailing Address Fax Number:
817-514-5210

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3323 COLORADO BLVD
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
DENTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76210-6867
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
940-387-8888
Provider Business Practice Location Address Fax Number:
940-387-8889
Provider Enumeration Date:
01/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  099006171RN , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 210585 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




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