Provider Demographics
NPI:1215119979
Name:DAVIS, GAIL A (RN)
Entity type:Individual
Prefix:MRS
First Name:GAIL
Middle Name:A
Last Name:DAVIS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 123
Mailing Address - Street 2:
Mailing Address - City:GROTON
Mailing Address - State:VT
Mailing Address - Zip Code:05046-0123
Mailing Address - Country:US
Mailing Address - Phone:802-584-3854
Mailing Address - Fax:
Practice Address - Street 1:1161 SCOTT HIGHWAY
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:VT
Practice Address - Zip Code:05046
Practice Address - Country:US
Practice Address - Phone:802-584-3854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-04
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT026-0021734163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care