Provider Demographics
NPI:1114630704
Name:GAVIT, KAYLA DIANE (RN)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:DIANE
Last Name:GAVIT
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 1:1805 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:SAULT SAINTE MARIE
Mailing Address - State:MI
Mailing Address - Zip Code:49783-1305
Mailing Address - Country:US
Mailing Address - Phone:906-430-7118
Mailing Address - Fax:
Practice Address - Street 1:1805 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:SAULT SAINTE MARIE
Practice Address - State:MI
Practice Address - Zip Code:49783-1305
Practice Address - Country:US
Practice Address - Phone:906-430-7118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-29
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704313485163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health