Provider Demographics
NPI:1578626735
Name:GAFT, RICHARD STEVEN (ANCC, FNP)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:STEVEN
Last Name:GAFT
Suffix:
Gender:M
Credentials:ANCC, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 N WASHINGTON ST
Mailing Address - Street 2:PO BOX 114
Mailing Address - City:PRESCOTT
Mailing Address - State:MI
Mailing Address - Zip Code:48756-5117
Mailing Address - Country:US
Mailing Address - Phone:989-873-3352
Mailing Address - Fax:
Practice Address - Street 1:125 N WASHINGTON ST
Practice Address - Street 2:BOX 114
Practice Address - City:PRESCOTT
Practice Address - State:MI
Practice Address - Zip Code:48756-5117
Practice Address - Country:US
Practice Address - Phone:989-873-3352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704201154207P00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5008774320OtherBCBS
MIMI1172OtherMEDICARE GROUP NUMBER
MIMI1172OtherMEDICARE GROUP NUMBER
MIMI1172002Medicare PIN
MI5008774320OtherBCBS