Provider Demographics
NPI:1952385759
Name:PHILLIPS, GAIL (CNW)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:CNW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 STATE ST
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-2250
Mailing Address - Country:US
Mailing Address - Phone:518-339-2526
Mailing Address - Fax:413-587-3786
Practice Address - Street 1:61 LOCUST ST
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-2018
Practice Address - Country:US
Practice Address - Phone:413-584-2303
Practice Address - Fax:413-587-3786
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2024-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA90449367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife