Healthcare Provider Details
I. General information
NPI: 1760638597
Provider Name (Legal Business Name): GAIL H. GANO CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N
II. Dates (important events)
Enumeration Date: 08/12/2008
Last Update Date: 09/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
6701 AIRPORT BLVD STE A101
MOBILE AL
36608-6705
US
IV. Provider business mailing address
PO BOX 850489
MOBILE AL
36685-0489
US
V. Phone/Fax
- Phone: 251-633-8880
- Fax: 251-633-2817
- Phone: 251-342-3949
- Fax: 251-631-3361
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 363LA2100X |
| Taxonomy | Acute Care Nurse Practitioner |
| License Number | 1-052614 |
| License Number State | AL |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone: