MEDICARE: GEM HEALTH & WELLNESS

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	363LP2300X	Primary Care Nurse Practitioner

General Provider Information

NPI Number	:	1992277008
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GEM HEALTH & WELLNESS

Provider Business Mailing 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

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	:	OWNER
Name	:	GAYLE E MYERS
Credential	:	CNP
Telephone Number	:	207-712-6068

Provider Enumeration Date	:	12/31/2018
Last Update Date	:	12/31/2018

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Directions to “GEM HEALTH & WELLNESS ” Practice Location

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