Provider Demographics
NPI:1730188467
Name:GAYNOR, BEATRICE M (NP)
Entity type:Individual
Prefix:
First Name:BEATRICE
Middle Name:M
Last Name:GAYNOR
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1275S STATE ST
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19901-6927
Mailing Address - Country:US
Mailing Address - Phone:302-672-2319
Mailing Address - Fax:302-672-2341
Practice Address - Street 1:25 N COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19716-3799
Practice Address - Country:US
Practice Address - Phone:302-831-3195
Practice Address - Fax:302-831-3193
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELG0000166363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000033545Medicaid
DE1000033545Medicaid
P56721Medicare UPIN
DE003707C90Medicare PIN