Provider Demographics
NPI:1013674159
Name:MARTIN, GAIL L
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:L
Last Name:MARTIN
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 1:1015 6TH ST
Mailing Address - Street 2:
Mailing Address - City:BEAVER CITY
Mailing Address - State:NE
Mailing Address - Zip Code:68926-2842
Mailing Address - Country:US
Mailing Address - Phone:308-655-0527
Mailing Address - Fax:
Practice Address - Street 1:1015 6TH ST
Practice Address - Street 2:
Practice Address - City:BEAVER CITY
Practice Address - State:NE
Practice Address - Zip Code:68926-2842
Practice Address - Country:US
Practice Address - Phone:308-655-0527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-23
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEH14025366172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver