1811495971 NPI number — GWENDOLYN ANN HILL NURSING ASSISTANT

Table of content: GWENDOLYN ANN HILL NURSING ASSISTANT (NPI 1811495971)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811495971 NPI number — GWENDOLYN ANN HILL NURSING ASSISTANT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HILL
Provider First Name:
GWENDOLYN
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NURSING ASSISTANT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HILL
Provider Other First Name:
GWENDOLYN
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1811495971
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/24/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3517 GOLDEN DR. APT C
Provider Second Line Business Mailing Address:
3517 GOLDEN DR. APT C
Provider Business Mailing Address City Name:
CHALMETT
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70043
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-296-0328
Provider Business Mailing Address Fax Number:
504-962-7364

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3517 GOLDEN DR. APT C
Provider Second Line Business Practice Location Address:
3517 GOLDEN DR. APT C
Provider Business Practice Location Address City Name:
CHALMETT
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70043
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-296-0328
Provider Business Practice Location Address Fax Number:
504-962-7364
Provider Enumeration Date:
01/24/2018

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: 251E00000X , with the licence number:  BS4059124K , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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