Provider Demographics
NPI:1134313893
Name:GILLES, EMMANUELLA (RN)
Entity Type:Individual
Prefix:
First Name:EMMANUELLA
Middle Name:
Last Name:GILLES
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 1:55 AZALIA CT
Mailing Address - Street 2:
Mailing Address - City:HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11550-1101
Mailing Address - Country:US
Mailing Address - Phone:516-486-5819
Mailing Address - Fax:
Practice Address - Street 1:55 AZALIA CT
Practice Address - Street 2:
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550-1101
Practice Address - Country:US
Practice Address - Phone:516-486-5819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-05
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22524781163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice