Provider Demographics
NPI:1063075430
Name:ROSENHOLM, GAIL ADELINE (PNP)
Entity type:Individual
Prefix:
First Name:GAIL
Middle Name:ADELINE
Last Name:ROSENHOLM
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6713 SERAH LN
Mailing Address - Street 2:
Mailing Address - City:JAMESVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13078-9690
Mailing Address - Country:US
Mailing Address - Phone:315-426-3600
Mailing Address - Fax:
Practice Address - Street 1:6713 SERAH LN
Practice Address - Street 2:
Practice Address - City:JAMESVILLE
Practice Address - State:NY
Practice Address - Zip Code:13078-9690
Practice Address - Country:US
Practice Address - Phone:315-380-6195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-20
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY656692163WP0808X
NYF406079-01363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health