Provider Demographics
NPI:1962538066
Name:BOZZELLA, GAIL YVONNE (MAC, LAC)
Entity type:Individual
Prefix:MRS
First Name:GAIL
Middle Name:YVONNE
Last Name:BOZZELLA
Suffix:
Gender:F
Credentials:MAC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3231 SUPERIOR LN
Mailing Address - Street 2:SUITE A-2
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20715-1923
Mailing Address - Country:US
Mailing Address - Phone:240-547-0559
Mailing Address - Fax:240-547-0561
Practice Address - Street 1:3231 SUPERIOR LN
Practice Address - Street 2:SUITE A-2
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-1923
Practice Address - Country:US
Practice Address - Phone:240-547-0559
Practice Address - Fax:240-547-0561
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU01031171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist