Healthcare Provider Details

I. General information

NPI: 1831025337
Provider Name (Legal Business Name): GAIL NICOLE BOTT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 W GENESEE ST
SYRACUSE NY
13204-2311
US

IV. Provider business mailing address

20324 SMITH ST
CARTHAGE NY
13619-8640
US

V. Phone/Fax

Practice location:
  • Phone: 702-573-0727
  • Fax:
Mailing address:
  • Phone: 702-573-0727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number349067
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: