Provider Demographics
NPI:1497286652
Name:GILLETTE, DARLENE (RN)
Entity Type:Individual
Prefix:
First Name:DARLENE
Middle Name:
Last Name:GILLETTE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2216 WOOD ST
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-3730
Mailing Address - Country:US
Mailing Address - Phone:517-290-1211
Mailing Address - Fax:
Practice Address - Street 1:2216 WOOD ST
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-3730
Practice Address - Country:US
Practice Address - Phone:517-290-1211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-21
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704125187163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse