Provider Demographics
NPI:1558382440
Name:KRIVAN, GAIL P (MD)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:P
Last Name:KRIVAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60045
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89506-0001
Mailing Address - Country:US
Mailing Address - Phone:775-461-3132
Mailing Address - Fax:775-461-3121
Practice Address - Street 1:896 W NYE LN STE 102
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89703-1567
Practice Address - Country:US
Practice Address - Phone:775-461-3132
Practice Address - Fax:775-461-3132
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV97352081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002013858Medicaid
H53166Medicare UPIN
101222Medicare ID - Type Unspecified