Provider Demographics
NPI:1851795868
Name:GALL, RHONDA
Entity Type:Individual
Prefix:MS
First Name:RHONDA
Middle Name:
Last Name:GALL
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:RHONDA
Other - Middle Name:J
Other - Last Name:GALL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN
Mailing Address - Street 1:14000 JERICHO PARK RD
Mailing Address - Street 2:CLT 208
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20715-3319
Mailing Address - Country:US
Mailing Address - Phone:301-860-3216
Mailing Address - Fax:
Practice Address - Street 1:14000 JERICHO PARK RD
Practice Address - Street 2:CLT 208
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-3319
Practice Address - Country:US
Practice Address - Phone:301-860-3216
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-20
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN37148363LG0600X
VA0024164351363LG0600X
MDR065433363LP0808X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health