Provider Demographics
NPI:1275031015
Name:MASLAKOW, GAYLE J (FNP-C, CDE)
Entity Type:Individual
Prefix:MS
First Name:GAYLE
Middle Name:J
Last Name:MASLAKOW
Suffix:
Gender:F
Credentials:FNP-C, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N10565 GRANDVIEW LN
Mailing Address - Street 2:
Mailing Address - City:IRONWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:49938-9622
Mailing Address - Country:US
Mailing Address - Phone:906-932-1500
Mailing Address - Fax:
Practice Address - Street 1:N10565 GRANDVIEW LN
Practice Address - Street 2:
Practice Address - City:IRONWOOD
Practice Address - State:MI
Practice Address - Zip Code:49938-9622
Practice Address - Country:US
Practice Address - Phone:906-932-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-26
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704300600163WD0400X, 363LP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care