Provider Demographics
NPI:1609140672
Name:GALL, MARYBETH (RNFA)
Entity Type:Individual
Prefix:MRS
First Name:MARYBETH
Middle Name:
Last Name:GALL
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:626 ADMIRAL DR
Mailing Address - Street 2:SUITE 748
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-2151
Mailing Address - Country:US
Mailing Address - Phone:410-310-8177
Mailing Address - Fax:
Practice Address - Street 1:626C ADMIRAL DR
Practice Address - Street 2:SUITE 748
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-2151
Practice Address - Country:US
Practice Address - Phone:410-310-8177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-08
Last Update Date:2012-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR153398163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant