MEDICARE: MR. JONATHAN DAVID GAIR MA, BSN, PHN, RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WC0200X	Critical Care Medicine Registered Nurse	R 160600-5	MN
2	163WG0600X	Gerontology Registered Nurse	R-160600-5	MN
3	163WG0100X	Gastroenterology Registered Nurse	R-160600-5	MN
4	163WG0000X	General Practice Registered Nurse	R-160600-5	MN

General Provider Information

NPI Number	:	1295777290
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JONATHAN DAVID GAIR MA, BSN, PHN, RN

Provider Business Mailing Address
First Line	:	901 W 44TH ST
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55409-1703
Country	:	US
Telephone Number	:	612-825-0413
Fax Number	:

Provider Business Practice Location Address
First Line	:	901 W 44TH ST
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55409-1703
Country	:	US
Telephone Number	:	612-825-0413
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/12/2006
Last Update Date	:	05/27/2014

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