Provider Demographics
NPI:1225277338
Name:NOLLER, GAYLE RENEE (RN)
Entity Type:Individual
Prefix:MS
First Name:GAYLE
Middle Name:RENEE
Last Name:NOLLER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
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Mailing Address - Street 1:2558 VENTNOR DR
Mailing Address - Street 2:
Mailing Address - City:PARK CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67219-1751
Mailing Address - Country:US
Mailing Address - Phone:316-305-6744
Mailing Address - Fax:316-440-3905
Practice Address - Street 1:1035 N EMPORIA ST
Practice Address - Street 2:SUITE 155
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-2944
Practice Address - Country:US
Practice Address - Phone:316-440-3900
Practice Address - Fax:316-440-3905
Is Sole Proprietor?:No
Enumeration Date:2009-02-12
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS13-78671-052163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator