Provider Demographics
NPI:1780735332
Name:THARPE-LUCERO, GAIL L (PA-C)
Entity type:Individual
Prefix:
First Name:GAIL
Middle Name:L
Last Name:THARPE-LUCERO
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 1:225 FRONT ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-1251
Mailing Address - Country:US
Mailing Address - Phone:907-463-4201
Mailing Address - Fax:907-463-6617
Practice Address - Street 1:225 FRONT ST
Practice Address - Street 2:SUITE 202
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-1251
Practice Address - Country:US
Practice Address - Phone:907-463-4201
Practice Address - Fax:907-463-6617
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1600363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK8EC323Medicare UPIN
AK8EC326Medicare UPIN
AK8EC325Medicare UPIN
AK8EC327Medicare UPIN
AK8EE323Medicare PIN
AK8EC324Medicare UPIN
Q59010Medicare UPIN