Provider Demographics
NPI:1699916734
Name:GAYLE-LAWSON, TRIESHA S (ANP)
Entity type:Individual
Prefix:
First Name:TRIESHA
Middle Name:S
Last Name:GAYLE-LAWSON
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:TRIESHA
Other - Middle Name:S
Other - Last Name:GAYLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PMHNP, ANP, DNP
Mailing Address - Street 1:44 EDWARDS RD
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-4004
Mailing Address - Country:US
Mailing Address - Phone:516-633-4660
Mailing Address - Fax:
Practice Address - Street 1:44 EDWARDS RD
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-4004
Practice Address - Country:US
Practice Address - Phone:516-633-4660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-19
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF304333-1363LA2200X
NJ26NJ00549500363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health