1497852719 NPI number — MRS. GAIL ANN STEVENS CRNP-F

Table of content: MRS. GAIL ANN STEVENS CRNP-F (NPI 1497852719)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497852719 NPI number — MRS. GAIL ANN STEVENS CRNP-F

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STEVENS
Provider First Name:
GAIL
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CRNP-F
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:
1497852719
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
202 SHEFFIELD AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALISBURY
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21804-5613
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-860-0611
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
WICOMICO MIDDLE SCHOOL WELLNESS CENTER,WICOMICO COUNTY
Provider Second Line Business Practice Location Address:
108 EAST MAIN STREET
Provider Business Practice Location Address City Name:
SALISBURY
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-219-2842
Provider Business Practice Location Address Fax Number:
410-341-7968
Provider Enumeration Date:
09/20/2006

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:  RO51367 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 472278 . This is a "VALUE OPIONS" identifier . This identifiers is of the category "OTHER".
  • Identifier: PK1000067101 . This is a "APS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0011 . This is a "DCB/S" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".




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