Provider Demographics
NPI:1801676671
Name:BRACK, GAIL F (LPN)
Entity type:Individual
Prefix:
First Name:GAIL
Middle Name:F
Last Name:BRACK
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 E 7TH ST # B
Mailing Address - Street 2:
Mailing Address - City:HAYS
Mailing Address - State:KS
Mailing Address - Zip Code:67601-4133
Mailing Address - Country:US
Mailing Address - Phone:888-878-6881
Mailing Address - Fax:316-469-0806
Practice Address - Street 1:207 E 7TH ST # B
Practice Address - Street 2:
Practice Address - City:HAYS
Practice Address - State:KS
Practice Address - Zip Code:67601-4133
Practice Address - Country:US
Practice Address - Phone:888-878-6881
Practice Address - Fax:316-469-0806
Is Sole Proprietor?:No
Enumeration Date:2023-09-29
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS23-12997164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse