Provider Demographics
NPI:1871651778
Name:CAVALLO, GAIL A (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:GAIL
Middle Name:A
Last Name:CAVALLO
Suffix:
Gender:F
Credentials:CRNP
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Mailing Address - Street 1:2101 E JEFFERSON ST
Mailing Address - Street 2:KAISER PERMANENTE MEDICARE ENROLLMENT
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4908
Mailing Address - Country:US
Mailing Address - Phone:301-816-2424
Mailing Address - Fax:301-816-6308
Practice Address - Street 1:6104 OLD BRANCH AVE
Practice Address - Street 2:KAISER PERMANENTE CAMP SPRINGS MEDICAL CENTER
Practice Address - City:TEMPLE HILLS
Practice Address - State:MD
Practice Address - Zip Code:20748-2518
Practice Address - Country:US
Practice Address - Phone:301-702-6100
Practice Address - Fax:301-702-6209
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2013-02-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDR062319363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
596293Medicare UPIN
004688M92Medicare ID - Type Unspecified