Provider Demographics
NPI:1538475637
Name:GALE, MEREDITH GRAHAM
Entity Type:Individual
Prefix:MRS
First Name:MEREDITH
Middle Name:GRAHAM
Last Name:GALE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MEREDITH
Other - Middle Name:G
Other - Last Name:GALE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:724 BROADMOOR AVE
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70364-1959
Mailing Address - Country:US
Mailing Address - Phone:985-226-7395
Mailing Address - Fax:
Practice Address - Street 1:2632 HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:LABADIEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70372-2045
Practice Address - Country:US
Practice Address - Phone:985-526-1699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-26
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN114959163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse