Provider Demographics
NPI:1861830283
Name:BARTAL, GAYLE H (RN)
Entity Type:Individual
Prefix:MRS
First Name:GAYLE
Middle Name:H
Last Name:BARTAL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 WREN SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:PIEDMONT
Mailing Address - State:SC
Mailing Address - Zip Code:29673-8028
Mailing Address - Country:US
Mailing Address - Phone:864-850-5930
Mailing Address - Fax:
Practice Address - Street 1:1010 WREN SCHOOL RD
Practice Address - Street 2:
Practice Address - City:PIEDMONT
Practice Address - State:SC
Practice Address - Zip Code:29673-8028
Practice Address - Country:US
Practice Address - Phone:864-850-5930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-07
Last Update Date:2013-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCRN.84948 R251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1104973577Medicaid