Provider Demographics
NPI:1588645220
Name:OTOOLE, GAIL A (ANP)
Entity Type:Individual
Prefix:MRS
First Name:GAIL
Middle Name:A
Last Name:OTOOLE
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 LIBBEY PKWY
Mailing Address - Street 2:STE 200
Mailing Address - City:WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02189-3129
Mailing Address - Country:US
Mailing Address - Phone:781-335-9700
Mailing Address - Fax:781-335-9709
Practice Address - Street 1:90 LIBBEY PKWY
Practice Address - Street 2:STE 200
Practice Address - City:WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02189-3129
Practice Address - Country:US
Practice Address - Phone:781-335-9700
Practice Address - Fax:781-335-9709
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2007-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA148056363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANP1431OtherBCBS
MA0340880Medicaid
MANP1431Medicare ID - Type Unspecified
MA0340880Medicaid