Provider Demographics
NPI:1194139485
Name:GALL, MICAYLA GRACE (LM, CPM, RN)
Entity type:Individual
Prefix:
First Name:MICAYLA
Middle Name:GRACE
Last Name:GALL
Suffix:
Gender:F
Credentials:LM, CPM, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5113 COUNTY ROAD M
Mailing Address - Street 2:
Mailing Address - City:WEST BEND
Mailing Address - State:WI
Mailing Address - Zip Code:53095-9751
Mailing Address - Country:US
Mailing Address - Phone:262-483-0195
Mailing Address - Fax:
Practice Address - Street 1:5113 COUNTY ROAD M
Practice Address - Street 2:
Practice Address - City:WEST BEND
Practice Address - State:WI
Practice Address - Zip Code:53095-9751
Practice Address - Country:US
Practice Address - Phone:262-483-0195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-16
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI201248-30163W00000X
WI303-49176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No163W00000XNursing Service ProvidersRegistered Nurse