Provider Demographics
NPI:1891839056
Name:DETWEILER-SHOSTAK, GAIL PATRICIA (RN)
Entity Type:Individual
Prefix:MRS
First Name:GAIL
Middle Name:PATRICIA
Last Name:DETWEILER-SHOSTAK
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 1:50 COLWELL ST
Mailing Address - Street 2:
Mailing Address - City:BURGETTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15021-2361
Mailing Address - Country:US
Mailing Address - Phone:412-889-1324
Mailing Address - Fax:
Practice Address - Street 1:50 COLWELL ST
Practice Address - Street 2:
Practice Address - City:BURGETTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15021-2361
Practice Address - Country:US
Practice Address - Phone:412-889-1324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN195330L364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
854366OtherHIGHMARK