Provider Demographics
NPI:1346398286
Name:BESETH, GAY M (NP)
Entity type:Individual
Prefix:MRS
First Name:GAY
Middle Name:M
Last Name:BESETH
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:510 N 13TH AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-4965
Mailing Address - Country:US
Mailing Address - Phone:909-920-0525
Mailing Address - Fax:909-920-0526
Practice Address - Street 1:510 N 13TH AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4965
Practice Address - Country:US
Practice Address - Phone:909-920-0525
Practice Address - Fax:909-920-0526
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2016-02-16
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Provider Licenses
StateLicense IDTaxonomies
CANP10839363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1346398286OtherUPIN