Provider Demographics
NPI:1275146136
Name:GIL, MADISON NICOLE
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:NICOLE
Last Name:GIL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9416 SHELLFISH CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-0267
Mailing Address - Country:US
Mailing Address - Phone:702-498-7929
Mailing Address - Fax:
Practice Address - Street 1:4956 DRIFTING PEBBLE ST
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89081-3057
Practice Address - Country:US
Practice Address - Phone:702-763-0416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-28
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant