Provider Demographics
NPI:1790021871
Name:GAINES, WILMA CARTER
Entity Type:Individual
Prefix:MRS
First Name:WILMA
Middle Name:CARTER
Last Name:GAINES
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 1:2205 SPANISH TOWN AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031
Mailing Address - Country:US
Mailing Address - Phone:702-658-9563
Mailing Address - Fax:
Practice Address - Street 1:1701 N GREEN VALLEY PKWY STE 9A
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-5991
Practice Address - Country:US
Practice Address - Phone:702-407-1100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-18
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner