Provider Demographics
NPI:1003955527
Name:GREMILLION, RAYSHAWN KEMYATTA
Entity Type:Individual
Prefix:
First Name:RAYSHAWN
Middle Name:KEMYATTA
Last Name:GREMILLION
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:UNITY
Other - Middle Name:FAMILY
Other - Last Name:SERVICE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2714 CANAL ST
Mailing Address - Street 2:310
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119-5548
Mailing Address - Country:US
Mailing Address - Phone:504-948-3322
Mailing Address - Fax:504-948-9190
Practice Address - Street 1:2714 CANAL ST
Practice Address - Street 2:310
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-5548
Practice Address - Country:US
Practice Address - Phone:504-948-3322
Practice Address - Fax:504-948-9190
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA119873747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1152137Medicaid
LA1171981Medicaid
LA1152111Medicaid
LA1152129Medicaid