Provider Demographics
NPI:1609173574
Name:GILL, KAREN MARLENE (RN)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:MARLENE
Last Name:GILL
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 1:920 ELWOOD ST
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:NY
Mailing Address - Zip Code:13440-2933
Mailing Address - Country:US
Mailing Address - Phone:315-533-6097
Mailing Address - Fax:
Practice Address - Street 1:1500 GENESEE STREET
Practice Address - Street 2:MENTAL HEALTH CONNECTIONS
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-5104
Practice Address - Country:US
Practice Address - Phone:315-735-9501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-11
Last Update Date:2011-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY329316-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03007343OtherROME NY MENTAL HEALTH CONNECTIONS: 01158465