Provider Demographics
NPI:1124399332
Name:GULL, JAYMIE H (RN)
Entity Type:Individual
Prefix:
First Name:JAYMIE
Middle Name:H
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:PO BOX 1078
Mailing Address - Street 2:
Mailing Address - City:PAROWAN
Mailing Address - State:UT
Mailing Address - Zip Code:84761-1078
Mailing Address - Country:US
Mailing Address - Phone:435-559-0466
Mailing Address - Fax:
Practice Address - Street 1:440 N PAIUTE DR
Practice Address - Street 2:
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84721-6181
Practice Address - Country:US
Practice Address - Phone:435-586-1112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-19
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5659139-3102163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse