MEDICARE: GAYLE LOUISE SCHNELL

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	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1417446162
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GAYLE LOUISE SCHNELL

Provider Business Mailing Address
First Line	:	2176 BARRANCA DR
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403-3109
Country	:	US
Telephone Number	:	541-729-8899
Fax Number	:

Provider Business Practice Location Address
First Line	:	2176 BARRANCA DR
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403-3109
Country	:	US
Telephone Number	:	541-729-8899
Fax Number	:

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

Provider Enumeration Date	:	05/08/2018
Last Update Date	:	05/08/2018

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Directions to “ GAYLE LOUISE SCHNELL ” Practice Location

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