Provider Demographics
NPI:1063639094
Name:MISA, GAIL E (RN)
Entity type:Individual
Prefix:MS
First Name:GAIL
Middle Name:E
Last Name:MISA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:764 HILLTOP CT.
Mailing Address - Street 2:
Mailing Address - City:CORAM
Mailing Address - State:NY
Mailing Address - Zip Code:11727
Mailing Address - Country:US
Mailing Address - Phone:631-838-4614
Mailing Address - Fax:631-863-1970
Practice Address - Street 1:3075 VETERANS MEMORIAL HIGHWAY
Practice Address - Street 2:SUITE 180
Practice Address - City:RONKONKOMA
Practice Address - State:NY
Practice Address - Zip Code:11779
Practice Address - Country:US
Practice Address - Phone:631-979-8009
Practice Address - Fax:631-863-1970
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY475086-1163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health