Provider Demographics
NPI:1801012299
Name:MANCEVICH, GAIL A
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:A
Last Name:MANCEVICH
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 1:2378 MARJORIE LN
Mailing Address - Street 2:
Mailing Address - City:CLIO
Mailing Address - State:MI
Mailing Address - Zip Code:48420-9161
Mailing Address - Country:US
Mailing Address - Phone:810-253-3888
Mailing Address - Fax:810-496-8539
Practice Address - Street 1:303 W WATER ST
Practice Address - Street 2:SUITE 100
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48503-5627
Practice Address - Country:US
Practice Address - Phone:810-253-3888
Practice Address - Fax:810-496-8539
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704128821163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health