Provider Demographics
NPI:1073767869
Name:GILL, KATHLEEN NORA (RN, HTP)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:NORA
Last Name:GILL
Suffix:
Gender:F
Credentials:RN, HTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 COLTS NECK RD
Mailing Address - Street 2:
Mailing Address - City:MANAHAWKIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08050-7889
Mailing Address - Country:US
Mailing Address - Phone:609-978-8028
Mailing Address - Fax:
Practice Address - Street 1:17 COLTS NECK RD
Practice Address - Street 2:
Practice Address - City:MANAHAWKIN
Practice Address - State:NJ
Practice Address - Zip Code:08050-7889
Practice Address - Country:US
Practice Address - Phone:609-978-8028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-06
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR04004200163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse