Provider Demographics
NPI:1831365063
Name:BOTTOMLEY, GAIL (NP)
Entity type:Individual
Prefix:MS
First Name:GAIL
Middle Name:
Last Name:BOTTOMLEY
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 1:2899 ELMWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-2019
Mailing Address - Country:US
Mailing Address - Phone:212-781-0677
Mailing Address - Fax:
Practice Address - Street 1:1580 ELMWOOD AVE STE 1E
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620-3620
Practice Address - Country:US
Practice Address - Phone:585-305-7934
Practice Address - Fax:949-404-6353
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-07
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY302528363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty