Provider Demographics
NPI:1760798136
Name:FARMER, GAIL MOORE
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:MOORE
Last Name:FARMER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1279 LIONS HEALTH CAMP RD
Mailing Address - Street 2:
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-8787
Mailing Address - Country:US
Mailing Address - Phone:724-859-9577
Mailing Address - Fax:
Practice Address - Street 1:2904 SEMINARY DR
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-3786
Practice Address - Country:US
Practice Address - Phone:724-832-8272
Practice Address - Fax:724-837-8278
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-24
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN002959133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1024723440001Medicaid