Provider Demographics
NPI:1659929156
Name:BACAN, GALE E
Entity Type:Individual
Prefix:MRS
First Name:GALE
Middle Name:E
Last Name:BACAN
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:GALE
Other - Middle Name:E
Other - Last Name:WELMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1703 MONROE AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72653
Mailing Address - Country:US
Mailing Address - Phone:870-421-5189
Mailing Address - Fax:
Practice Address - Street 1:1703 MONROE AVE
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653
Practice Address - Country:US
Practice Address - Phone:870-421-5189
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-28
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider