Provider Demographics
NPI:1457370298
Name:GAMEL, MARY ANN (MSN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ANN
Last Name:GAMEL
Suffix:
Gender:F
Credentials:MSN, FNP-BC
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:ANN
Other - Last Name:CHANCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:22 BERMUDA LN
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-2902
Mailing Address - Country:US
Mailing Address - Phone:903-291-3456
Mailing Address - Fax:903-663-1722
Practice Address - Street 1:22 BERMUDA LN
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-2902
Practice Address - Country:US
Practice Address - Phone:903-291-3456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX620402363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP05739Medicare UPIN