Basic Information
| Provider Information | |||||||||
| NPI: | 1932491917 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GAY | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | FLORENCE MILEY | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | NP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MILEY | ||||||||
| OtherFirstName: | JENNIFER | ||||||||
| OtherMiddleName: | FLORENCE | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | NP | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 780 ALBANY ST | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021182524 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8576541000 | ||||||||
| FaxNumber: | 8576541100 | ||||||||
| Practice Location | |||||||||
| Address1: | 780 ALBANY ST | ||||||||
| Address2: | BOSTON HEALTHCARE FOR THE HOMELESS PROGRAM | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021182524 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8576541000 | ||||||||
| FaxNumber: | 8576541100 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2011 | ||||||||
| LastUpdateDate: | 04/20/2015 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
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| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | RN2264381 | MA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.