Provider Demographics
NPI:1548424443
Name:HILL, GWENDOLYN Y
Entity Type:Individual
Prefix:
First Name:GWENDOLYN
Middle Name:Y
Last Name:HILL
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 1:326 JAMES ST APT A
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32404-2533
Mailing Address - Country:US
Mailing Address - Phone:850-874-2554
Mailing Address - Fax:
Practice Address - Street 1:326 JAMES ST APT A
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32404-2533
Practice Address - Country:US
Practice Address - Phone:850-874-2554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-10
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator