Provider Demographics
NPI:1477868081
Name:DAVIDSON, GAYLE E (BSN, CRRN, CDE)
Entity Type:Individual
Prefix:MS
First Name:GAYLE
Middle Name:E
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:BSN, CRRN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-3822
Mailing Address - Country:US
Mailing Address - Phone:617-479-2607
Mailing Address - Fax:
Practice Address - Street 1:55 FOGG ROAD
Practice Address - Street 2:SOUTH SHORE HOSPITAL DIABETES CENTER
Practice Address - City:SOUTH WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02190
Practice Address - Country:US
Practice Address - Phone:781-624-4164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-09
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN190960163WD0400X, 163WR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
No163WR0400XNursing Service ProvidersRegistered NurseRehabilitation