Provider Demographics
NPI:1699847681
Name:HARRELL, GINA OTHEA
Entity Type:Individual
Prefix:MRS
First Name:GINA
Middle Name:OTHEA
Last Name:HARRELL
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 1:200 DRAGONFLY CIR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95834-2611
Mailing Address - Country:US
Mailing Address - Phone:916-928-9132
Mailing Address - Fax:
Practice Address - Street 1:825 EAST ST
Practice Address - Street 2:SUITE 302
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95776-4976
Practice Address - Country:US
Practice Address - Phone:530-402-2800
Practice Address - Fax:530-402-2809
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA514741163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator