Provider Demographics
NPI:1659394245
Name:DIBLASI, GAIL (RN, PMHCNS, BC)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:
Last Name:DIBLASI
Suffix:
Gender:F
Credentials:RN, PMHCNS, BC
Other - Prefix:
Other - First Name:GAIL
Other - Middle Name:
Other - Last Name:STAUDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, PMHCNS, BC
Mailing Address - Street 1:947 PENN AVE
Mailing Address - Street 2:
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-3018
Mailing Address - Country:US
Mailing Address - Phone:610-478-7115
Mailing Address - Fax:610-478-7118
Practice Address - Street 1:947 PENN AVE
Practice Address - Street 2:
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-3018
Practice Address - Country:US
Practice Address - Phone:610-478-7115
Practice Address - Fax:610-478-7118
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN169568L163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA109321K34Medicare PIN