Provider Demographics
NPI:1083778955
Name:KAPHAN, GAIL J (APRN)
Entity Type:Individual
Prefix:MRS
First Name:GAIL
Middle Name:J
Last Name:KAPHAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1985 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01103-1095
Mailing Address - Country:US
Mailing Address - Phone:413-733-6639
Mailing Address - Fax:
Practice Address - Street 1:1985 MAIN ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01103-1095
Practice Address - Country:US
Practice Address - Phone:413-733-6639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2016-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH033794-23-01367A00000X
NH03379423363L00000X, 367A00000X
MARN199067367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30344867Medicaid
NH30344867Medicaid
NHP36293Medicare UPIN
MAKA RN0149Medicare ID - Type Unspecified