Provider Demographics
NPI:1558962621
Name:GILLS, TINA RANAE
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:RANAE
Last Name:GILLS
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 1:9426 GALLIA PIKE RD
Mailing Address - Street 2:
Mailing Address - City:WHEELERSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45694-8475
Mailing Address - Country:US
Mailing Address - Phone:740-464-7266
Mailing Address - Fax:
Practice Address - Street 1:9426 GALLIA PIKE RD
Practice Address - Street 2:
Practice Address - City:WHEELERSBURG
Practice Address - State:OH
Practice Address - Zip Code:45694-8475
Practice Address - Country:US
Practice Address - Phone:740-464-7266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-05
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide