Healthcare Provider Details

I. General information

NPI: 1669484663
Provider Name (Legal Business Name): GAIL L. PRATER CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 WOODLAND AVE
PHILADELPHIA PA
19104-4551
US

IV. Provider business mailing address

1437 GROVANIA AVE
ABINGTON PA
19001-2517
US

V. Phone/Fax

Practice location:
  • Phone: 215-823-5800
  • Fax: 215-823-4425
Mailing address:
  • Phone: 215-706-0933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberTP 000882 C.
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: