Provider Demographics
NPI:1700963071
Name:BOAZ, GAIL M (APRN)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:M
Last Name:BOAZ
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:300 SOUTHBOROUGH DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-6914
Mailing Address - Country:US
Mailing Address - Phone:207-661-2000
Mailing Address - Fax:
Practice Address - Street 1:193 MAIN ST
Practice Address - Street 2:SUITE 9
Practice Address - City:NORWAY
Practice Address - State:ME
Practice Address - Zip Code:04268
Practice Address - Country:US
Practice Address - Phone:207-743-8766
Practice Address - Fax:207-743-1579
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2016-08-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MEAP081039363LP0200X
WAAP30006925363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics