Provider Demographics
NPI:1235393943
Name:GILL, VICTORIA (BSN RN)
Entity Type:Individual
Prefix:MS
First Name:VICTORIA
Middle Name:
Last Name:GILL
Suffix:
Gender:F
Credentials:BSN RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:NORTHEAST HEALTH CENTER 5400 EAST SEVEN MILE
Mailing Address - Street 2:ROOM 11
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48234
Mailing Address - Country:US
Mailing Address - Phone:313-870-3042
Mailing Address - Fax:313-368-4694
Practice Address - Street 1:NORTHEAST HEALTH CENTER 5400 EAST SEVEN MILE
Practice Address - Street 2:ROOM 11
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48234
Practice Address - Country:US
Practice Address - Phone:313-870-3042
Practice Address - Fax:313-368-4694
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-11
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704119518163W00000X, 163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
No163WC1500XNursing Service ProvidersRegistered NurseCommunity HealthGroup - Single Specialty