Provider Demographics
NPI:1508825019
Name:GALL, MARILYN J (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:MARILYN
Middle Name:J
Last Name:GALL
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
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Mailing Address - Street 1:500 CADMUS LN
Mailing Address - Street 2:STE 210
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-3857
Mailing Address - Country:US
Mailing Address - Phone:410-822-8550
Mailing Address - Fax:410-822-3741
Practice Address - Street 1:500 CADMUS LN
Practice Address - Street 2:STE 210
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-3857
Practice Address - Country:US
Practice Address - Phone:410-822-8550
Practice Address - Fax:410-822-3741
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2016-09-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDR049703363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KQ62497UMedicare ID - Type Unspecified