Provider Demographics
NPI:1063044170
Name:SACKETT, GAIL (RN)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:
Last Name:SACKETT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:JAMES E. ALLEN LEARNING CENTER
Mailing Address - Street 2:762 DEER PARK ROAD
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746
Mailing Address - Country:US
Mailing Address - Phone:631-667-2094
Mailing Address - Fax:631-623-4931
Practice Address - Street 1:JAMES E. ALLEN LEARNING CENTER
Practice Address - Street 2:762 DEER PARK ROAD
Practice Address - City:DIX HILLS
Practice Address - State:NY
Practice Address - Zip Code:11746
Practice Address - Country:US
Practice Address - Phone:631-667-2094
Practice Address - Fax:631-623-4931
Is Sole Proprietor?:No
Enumeration Date:2020-02-06
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY451341-1163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY451351Medicaid
NY451341-1Medicaid