Provider Demographics
NPI:1619927753
Name:HEFTER, GAIL (CRNP)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:
Last Name:HEFTER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 COYLE RD
Mailing Address - Street 2:#106
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-5088
Mailing Address - Country:US
Mailing Address - Phone:410-614-5343
Mailing Address - Fax:410-614-1168
Practice Address - Street 1:601 N CAROLINE ST
Practice Address - Street 2:# 7263
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287-0005
Practice Address - Country:US
Practice Address - Phone:410-614-5343
Practice Address - Fax:410-614-1168
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR053539363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD407155700Medicaid
MDQ40703Medicare UPIN
MD4109553116Medicare UPIN
MDKR34L020Medicare ID - Type Unspecified