Provider Demographics
NPI:1760501894
Name:GILLGRASS, SHEILA SWAN (RN ASN)
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:SWAN
Last Name:GILLGRASS
Suffix:
Gender:F
Credentials:RN ASN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2973 LAWYER DR
Mailing Address - Street 2:
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-9058
Mailing Address - Country:US
Mailing Address - Phone:510-837-2393
Mailing Address - Fax:
Practice Address - Street 1:2973 LAWYER DR
Practice Address - Street 2:
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-9058
Practice Address - Country:US
Practice Address - Phone:513-837-2393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN680784163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAEPS016630Medicaid
CARVN004780Medicaid