Provider Demographics
NPI:1932195740
Name:KIMMERLE, GAIL A (CRNA)
Entity type:Individual
Prefix:
First Name:GAIL
Middle Name:A
Last Name:KIMMERLE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1245 S CEDAR CREST BLVD
Mailing Address - Street 2:SUITE #301
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-6258
Mailing Address - Country:US
Mailing Address - Phone:610-402-8896
Mailing Address - Fax:610-402-9029
Practice Address - Street 1:17TH & CHEW STREET
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18102
Practice Address - Country:US
Practice Address - Phone:610-402-8896
Practice Address - Fax:610-402-9029
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2008-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN284139L163W00000X
PA045190367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2000726OtherKHP CENTRAL
PA50034713OtherCAPITAL ADVANTAGE
PAP00198553OtherRAIL ROAD MEDICARE
PA1627967OtherHIGHMARK
PA2304225000OtherINDEP. BLUE CROSS
PA87367OtherGEISINGER
PA1627967OtherHIGHMARK
PA50034713OtherCAPITAL ADVANTAGE