Provider Demographics
NPI:1518011600
Name:GULLETT, DOROTHY
Entity Type:Individual
Prefix:MS
First Name:DOROTHY
Middle Name:
Last Name:GULLETT
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 1:3478 N TOWNSHIP ROAD 175
Mailing Address - Street 2:
Mailing Address - City:REPUBLIC
Mailing Address - State:OH
Mailing Address - Zip Code:44867-9711
Mailing Address - Country:US
Mailing Address - Phone:419-680-2951
Mailing Address - Fax:
Practice Address - Street 1:3478 N TOWNSHIP ROAD 175
Practice Address - Street 2:
Practice Address - City:REPUBLIC
Practice Address - State:OH
Practice Address - Zip Code:44867-9711
Practice Address - Country:US
Practice Address - Phone:419-680-2951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2611829374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide