Provider Demographics
NPI:1316030976
Name:CROSLEY, GAYLE ANN (APRN-RX)
Entity Type:Individual
Prefix:MS
First Name:GAYLE
Middle Name:ANN
Last Name:CROSLEY
Suffix:
Gender:F
Credentials:APRN-RX
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1190 WAIANUENUE AVE
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-2089
Mailing Address - Country:US
Mailing Address - Phone:808-933-0468
Mailing Address - Fax:808-974-6967
Practice Address - Street 1:1190 WAIANUENUE AVE
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2089
Practice Address - Country:US
Practice Address - Phone:808-933-0468
Practice Address - Fax:808-974-6967
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN044365363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ316185Medicaid
AZZ120985Medicare PIN