Healthcare Provider Details

I. General information

NPI: 1639254048
Provider Name (Legal Business Name): GAYLE FRICKEL FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 EAST LOCUST STREET
LONE PINE CA
93545-1009
US

IV. Provider business mailing address

PO BOX 13
LONE PINE CA
93545-0013
US

V. Phone/Fax

Practice location:
  • Phone: 760-876-1146
  • Fax: 760-876-4046
Mailing address:
  • Phone: 760-876-1146
  • Fax: 760-876-4046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number164810
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: