Provider Demographics
NPI:1477649200
Name:ALBRITTON, GAYLE MARIE (NP)
Entity Type:Individual
Prefix:MRS
First Name:GAYLE
Middle Name:MARIE
Last Name:ALBRITTON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:GAYLE
Other - Middle Name:MARIE
Other - Last Name:MCHANEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:44200 WOODWARD AVE
Mailing Address - Street 2:SUITE 209
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48341-5045
Mailing Address - Country:US
Mailing Address - Phone:248-253-0330
Mailing Address - Fax:
Practice Address - Street 1:44200 WOODWARD AVE STE 209
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341-5045
Practice Address - Country:US
Practice Address - Phone:248-253-0330
Practice Address - Fax:248-253-1982
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704122012363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP28248Medicare UPIN