Provider Demographics
NPI:1629178256
Name:DANIELSON, GAIL L (PA-C)
Entity type:Individual
Prefix:
First Name:GAIL
Middle Name:L
Last Name:DANIELSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2975 HIGHWAY 2 E
Mailing Address - Street 2:
Mailing Address - City:RUGBY
Mailing Address - State:ND
Mailing Address - Zip Code:58368-7801
Mailing Address - Country:US
Mailing Address - Phone:701-776-5235
Mailing Address - Fax:701-776-5297
Practice Address - Street 1:2975 HIGHWAY 2 E
Practice Address - Street 2:
Practice Address - City:RUGBY
Practice Address - State:ND
Practice Address - Zip Code:58368-7801
Practice Address - Country:US
Practice Address - Phone:701-776-5235
Practice Address - Fax:701-776-5297
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDPAC0017363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1456479Medicaid
NDN714229OtherMEDICARE PTAN
NDN26302OtherBLUE SHIELD