Provider Demographics
NPI:1699707455
Name:DUSSERE, GAIL LAVENE (RN)
Entity type:Individual
Prefix:MRS
First Name:GAIL
Middle Name:LAVENE
Last Name:DUSSERE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:LAVENE
Other - Middle Name:GAIL
Other - Last Name:DUSSERE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:11117 CUTBANK CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:MC KENNEY
Mailing Address - State:VA
Mailing Address - Zip Code:23872-2411
Mailing Address - Country:US
Mailing Address - Phone:804-478-4936
Mailing Address - Fax:
Practice Address - Street 1:20 W BANK ST
Practice Address - Street 2:SUITE 6
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23803-3279
Practice Address - Country:US
Practice Address - Phone:804-862-8002
Practice Address - Fax:804-862-8023
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001078852163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health