1548520653 NPI number — RHONDA O GILLETTE

Table of content: RHONDA O GILLETTE (NPI 1548520653)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548520653 NPI number — RHONDA O GILLETTE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GILLETTE
Provider First Name:
RHONDA
Provider Middle Name:
O
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
OWENS
Provider Other First Name:
RHONDA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1548520653
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/15/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4325 W ROME BLVD
Provider Second Line Business Mailing Address:
#3197
Provider Business Mailing Address City Name:
NORTH LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89084-5497
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-409-8155
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4325 W ROME BLVD
Provider Second Line Business Practice Location Address:
#3197
Provider Business Practice Location Address City Name:
NORTH LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89084-5497
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-409-8155
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/22/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 225400000X . This is a "REHABILITATION PRACTITIONER" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".




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