Provider Demographics
NPI:1477737195
Name:THEBERGE, GAYLE M
Entity Type:Individual
Prefix:
First Name:GAYLE
Middle Name:M
Last Name:THEBERGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87 WASHINGTON STREET
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:NH
Mailing Address - Zip Code:03818
Mailing Address - Country:US
Mailing Address - Phone:603-447-3347
Mailing Address - Fax:603-447-8893
Practice Address - Street 1:3 TWELFTH STREET
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:NH
Practice Address - Zip Code:03570
Practice Address - Country:US
Practice Address - Phone:603-752-7404
Practice Address - Fax:603-752-5194
Is Sole Proprietor?:No
Enumeration Date:2007-12-18
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program