Provider Demographics
NPI:1447220728
Name:MYERS, GAYLE E (MSN ANP)
Entity Type:Individual
Prefix:
First Name:GAYLE
Middle Name:E
Last Name:MYERS
Suffix:
Gender:F
Credentials:MSN ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 US ROUTE 1
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-7609
Mailing Address - Country:US
Mailing Address - Phone:207-396-8600
Mailing Address - Fax:207-396-8632
Practice Address - Street 1:169 OCEAN ST STE 104
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-3636
Practice Address - Country:US
Practice Address - Phone:207-712-6068
Practice Address - Fax:207-747-4424
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP81087363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME30344481Medicaid
NH30344481Medicaid
ME432313599Medicaid
ME000289203Medicare PIN
ME432313599Medicaid
ME30344481Medicaid
VAD000Medicare UPIN
ME000289202Medicare PIN