MEDICARE: GAYLE E MYERS MSN ANP

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	363LA2200X	Adult Health Nurse Practitioner	CNP81087	ME

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447220728
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GAYLE E MYERS MSN ANP

Provider Business Mailing Address
First Line	:	301 US ROUTE 1
Second Line	:
City	:	SCARBOROUGH
State	:	ME
Zip	:	04074-7609
Country	:	US
Telephone Number	:	207-396-8600
Fax Number	:	207-396-8632

Provider Business Practice Location Address
First Line	:	169 OCEAN ST STE 104
Second Line	:
City	:	SOUTH PORTLAND
State	:	ME
Zip	:	04106-3636
Country	:	US
Telephone Number	:	207-712-6068
Fax Number	:	207-747-4424

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

Provider Enumeration Date	:	01/26/2006
Last Update Date	:	01/02/2019

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