Provider Demographics
NPI:1508155201
Name:GAGE, DINA M (FNP)
Entity Type:Individual
Prefix:
First Name:DINA
Middle Name:M
Last Name:GAGE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:159 JEFFERSON HTS
Mailing Address - Street 2:SUITE D107
Mailing Address - City:CATSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12414-1237
Mailing Address - Country:US
Mailing Address - Phone:518-943-1442
Mailing Address - Fax:518-943-2003
Practice Address - Street 1:159 JEFFERSON HTS
Practice Address - Street 2:SUITE D107
Practice Address - City:CATSKILL
Practice Address - State:NY
Practice Address - Zip Code:12414-1237
Practice Address - Country:US
Practice Address - Phone:518-943-1442
Practice Address - Fax:518-943-2003
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-04
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF336626-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily