Provider Demographics
NPI:1104163906
Name:REAM, GAIL M
Entity type:Individual
Prefix:
First Name:GAIL
Middle Name:M
Last Name:REAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8936 GREENACRE CT
Mailing Address - Street 2:
Mailing Address - City:GREENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53129-1543
Mailing Address - Country:US
Mailing Address - Phone:262-818-5418
Mailing Address - Fax:
Practice Address - Street 1:8936 GREENACRE CT
Practice Address - Street 2:
Practice Address - City:GREENDALE
Practice Address - State:WI
Practice Address - Zip Code:53129-1543
Practice Address - Country:US
Practice Address - Phone:262-818-5418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-14
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3181-26174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist