Provider Demographics
NPI:1396938551
Name:BEDDALL, GAIL
Entity type:Individual
Prefix:MRS
First Name:GAIL
Middle Name:
Last Name:BEDDALL
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 1:1404 E SUNSET CT
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85365-3517
Mailing Address - Country:US
Mailing Address - Phone:928-314-4516
Mailing Address - Fax:
Practice Address - Street 1:1404 E SUNSET CT
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85365-3517
Practice Address - Country:US
Practice Address - Phone:928-314-4516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-21
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ991267Medicaid