Provider Demographics
NPI:1871010173
Name:HOLDER, GAYNELLE GILLIAN
Entity Type:Individual
Prefix:
First Name:GAYNELLE
Middle Name:GILLIAN
Last Name:HOLDER
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 1:819 NOBLE AVE APT 0B
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10473-4107
Mailing Address - Country:US
Mailing Address - Phone:347-657-2349
Mailing Address - Fax:
Practice Address - Street 1:819 NOBLE AVE APT 0B
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10473-4107
Practice Address - Country:US
Practice Address - Phone:347-657-2349
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-28
Last Update Date:2017-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY329835164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse