Provider Demographics
NPI:1164739017
Name:GOSE-DAWKINS, ELLA
Entity Type:Individual
Prefix:MS
First Name:ELLA
Middle Name:
Last Name:GOSE-DAWKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:ELLA
Other - Middle Name:
Other - Last Name:DAWKINS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:6132 PASSIONATE CT
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-3538
Mailing Address - Country:US
Mailing Address - Phone:702-743-5908
Mailing Address - Fax:
Practice Address - Street 1:2349 RENAISSANCE DR
Practice Address - Street 2:SUITE A
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-6191
Practice Address - Country:US
Practice Address - Phone:702-743-5908
Practice Address - Fax:702-597-2242
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-13
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner