Provider Demographics
NPI:1609283233
Name:GILL, KAITLYN MICHAEL (CNA)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:MICHAEL
Last Name:GILL
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25826 176TH PL SE
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98042-8319
Mailing Address - Country:US
Mailing Address - Phone:206-719-3894
Mailing Address - Fax:
Practice Address - Street 1:25826 176TH PL SE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:WA
Practice Address - Zip Code:98042-8319
Practice Address - Country:US
Practice Address - Phone:206-719-3894
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-15
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANA 60447801390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program