Provider Demographics
NPI:1417530114
Name:GILL, DIONNE LERAE (CNA)
Entity Type:Individual
Prefix:
First Name:DIONNE
Middle Name:LERAE
Last Name:GILL
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:DIONNE
Other - Middle Name:LERAE
Other - Last Name:YOUNGBLOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNA
Mailing Address - Street 1:2005 GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:MONESSEN
Mailing Address - State:PA
Mailing Address - Zip Code:15062-2528
Mailing Address - Country:US
Mailing Address - Phone:724-288-8956
Mailing Address - Fax:
Practice Address - Street 1:2005 GRAND BLVD
Practice Address - Street 2:
Practice Address - City:MONESSEN
Practice Address - State:PA
Practice Address - Zip Code:15062-2528
Practice Address - Country:US
Practice Address - Phone:724-288-8956
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-30
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide