Basic Information
| Provider Information | |||||||||
| NPI: | 1669655783 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MICKALONIS | ||||||||
| FirstName: | GAIL | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 826 MAIN ST | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | PHOENIXVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194604459 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6104151100 | ||||||||
| FaxNumber: | 6104151101 | ||||||||
| Practice Location | |||||||||
| Address1: | 826 MAIN ST | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | PHOENIXVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194604459 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6104151100 | ||||||||
| FaxNumber: | 6104151101 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/12/2007 | ||||||||
| LastUpdateDate: | 11/16/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | SP009297 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.