Provider Demographics
NPI:1760450704
Name:CICCARELLO, GAIL PATRICIA (ACNP)
Entity type:Individual
Prefix:MS
First Name:GAIL
Middle Name:PATRICIA
Last Name:CICCARELLO
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 224
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:NY
Mailing Address - Zip Code:13775-0224
Mailing Address - Country:US
Mailing Address - Phone:607-829-2357
Mailing Address - Fax:
Practice Address - Street 1:BASSETT HEALTHCARE
Practice Address - Street 2:ONE ATWELL RD
Practice Address - City:COOPERSTOWN
Practice Address - State:NY
Practice Address - Zip Code:13326-1394
Practice Address - Country:US
Practice Address - Phone:607-544-2600
Practice Address - Fax:607-544-2604
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY430296363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care