Provider Demographics
NPI:1245284884
Name:BROCK, GAIL PACHARIS (NP)
Entity type:Individual
Prefix:MRS
First Name:GAIL
Middle Name:PACHARIS
Last Name:BROCK
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:DUKE UNIVERSITY MEDICAL CTR
Mailing Address - Street 2:7623B HOSPITAL NORTH BOX 3128
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27710-0001
Mailing Address - Country:US
Mailing Address - Phone:919-681-3810
Mailing Address - Fax:919-613-5137
Practice Address - Street 1:DUKE UNIVERSITY MEDICAL CTR
Practice Address - Street 2:7623B HOSPITAL NORTH BOX 3128
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27710-0001
Practice Address - Country:US
Practice Address - Phone:919-681-3810
Practice Address - Fax:919-613-5137
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC185982363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC037407700Medicaid
MD409415800Medicaid
DC018847W34Medicare ID - Type Unspecified
MD409415800Medicaid