Provider Demographics
NPI:1679781645
Name:MAICHUK, GAYLENE DORIS (APN)
Entity type:Individual
Prefix:MS
First Name:GAYLENE
Middle Name:DORIS
Last Name:MAICHUK
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 EDGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:NUTLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07110-1841
Mailing Address - Country:US
Mailing Address - Phone:973-667-3346
Mailing Address - Fax:
Practice Address - Street 1:150 BERGEN ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103-2496
Practice Address - Country:US
Practice Address - Phone:973-667-3346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ163WN0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WN0003XNursing Service ProvidersRegistered NurseNeonatal, Low-Risk