Provider Demographics
NPI:1558006510
Name:SEQUOIYAH, GABRIEL ELIJAH
Entity Type:Individual
Prefix:
First Name:GABRIEL
Middle Name:ELIJAH
Last Name:SEQUOIYAH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 C AVENUE
Mailing Address - Street 2:APT# C 35
Mailing Address - City:MCGILL
Mailing Address - State:NV
Mailing Address - Zip Code:89318
Mailing Address - Country:US
Mailing Address - Phone:775-213-1245
Mailing Address - Fax:
Practice Address - Street 1:35 C AVENUE
Practice Address - Street 2:APT# C 35
Practice Address - City:MCGILL
Practice Address - State:NV
Practice Address - Zip Code:89318
Practice Address - Country:US
Practice Address - Phone:775-213-1245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-03
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide