Provider Demographics
NPI:1629262498
Name:FEAGANS, GAIL ANN (RN, CNS)
Entity Type:Individual
Prefix:MS
First Name:GAIL
Middle Name:ANN
Last Name:FEAGANS
Suffix:
Gender:F
Credentials:RN, CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 ROSEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-1624
Mailing Address - Country:US
Mailing Address - Phone:301-351-5197
Mailing Address - Fax:301-345-2992
Practice Address - Street 1:115 ROSEWOOD DR
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-1624
Practice Address - Country:US
Practice Address - Phone:301-351-5197
Practice Address - Fax:301-345-2992
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-05
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR059191261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD490231Medicare PIN