Provider Demographics
NPI:1619090263
Name:HOOTMAN, GWENDOLYN MARIE (LVN)
Entity Type:Individual
Prefix:MRS
First Name:GWENDOLYN
Middle Name:MARIE
Last Name:HOOTMAN
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 FAIRWIND AVE
Mailing Address - Street 2:
Mailing Address - City:ROSAMOND
Mailing Address - State:CA
Mailing Address - Zip Code:93560-6633
Mailing Address - Country:US
Mailing Address - Phone:661-256-8180
Mailing Address - Fax:
Practice Address - Street 1:2689 SIERRA HIGHWAY
Practice Address - Street 2:BOX 1359
Practice Address - City:ROSAMOND
Practice Address - State:CA
Practice Address - Zip Code:93560
Practice Address - Country:US
Practice Address - Phone:661-256-7208
Practice Address - Fax:661-256-7209
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN198693164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse