Basic Information
Provider Information
NPI: 1801003611
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MAHER
FirstName: GAIL
MiddleName: E
NamePrefix: MS.
NameSuffix:  
Credential: BSNRN
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3142 VISTA WAY
Address2: SUITE 207
City: OCEANSIDE
State: CA
PostalCode: 920563619
CountryCode: US
TelephoneNumber: 7609677082
FaxNumber: 7609671465
Practice Location
Address1: 3142 VISTA WAY
Address2: SUITE 207
City: OCEANSIDE
State: CA
PostalCode: 920563619
CountryCode: US
TelephoneNumber: 7609677082
FaxNumber: 7609671465
Other Information
ProviderEnumerationDate: 05/17/2007
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163W00000X345326CAX Nursing Service ProvidersRegistered Nurse 
163WC0400X345326CAX Nursing Service ProvidersRegistered NurseCase Management

No ID Information.


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