Provider Demographics
NPI:1063639227
Name:GULL, REBECCA W (RN)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:W
Last Name:GULL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 N 1275 W
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-4341
Mailing Address - Country:US
Mailing Address - Phone:435-673-2856
Mailing Address - Fax:
Practice Address - Street 1:352 E RIVERSIDE DR
Practice Address - Street 2:A9
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-6758
Practice Address - Country:US
Practice Address - Phone:435-251-2888
Practice Address - Fax:435-986-6873
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT279210-3102163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT279210-3102OtherRN LICENSE