Provider Demographics
NPI:1649411935
Name:TEASLEY, GAIL (RN)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:
Last Name:TEASLEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5760 MOUNTAIN RANCH DR
Mailing Address - Street 2:
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84098-6175
Mailing Address - Country:US
Mailing Address - Phone:435-649-4107
Mailing Address - Fax:
Practice Address - Street 1:1441 UTE BLVD STE 220
Practice Address - Street 2:
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84098-7636
Practice Address - Country:US
Practice Address - Phone:435-513-0054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-16
Last Update Date:2009-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6915949-3102163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse