Individual
MRS. GAYLE PATRICIA IVY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
3909 TRILLIUM AVE, MODESTO, CA 95356-1319
(209) 529-5191
Mailing address
3909 TRILLIUM AVE, MODESTO, CA 95356-1319
(209) 529-5191
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
165354
CA
Other
Enumeration date
10/03/2007
Last updated
10/03/2007
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