Provider Demographics
NPI:1205020807
Name:WILLIAMS, GAIL Y (RN,DNP, CRNP)
Entity type:Individual
Prefix:MS
First Name:GAIL
Middle Name:Y
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:RN,DNP, CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 S 11TH ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-4824
Mailing Address - Country:US
Mailing Address - Phone:215-955-6702
Mailing Address - Fax:215-955-0412
Practice Address - Street 1:111 S 11TH ST
Practice Address - Street 2:BODINE CENTER
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107
Practice Address - Country:US
Practice Address - Phone:215-955-6702
Practice Address - Fax:215-955-0412
Is Sole Proprietor?:No
Enumeration Date:2007-08-28
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00141500363LA2200X
PASP009816363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102866670Medicaid
PA134517Medicare PIN