Provider Demographics
NPI:1902006638
Name:GAINES, JOSHLYN M (CNA)
Entity Type:Individual
Prefix:
First Name:JOSHLYN
Middle Name:M
Last Name:GAINES
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2377 PIERCE ST
Mailing Address - Street 2:
Mailing Address - City:GARY
Mailing Address - State:IN
Mailing Address - Zip Code:46407-3417
Mailing Address - Country:US
Mailing Address - Phone:219-677-0881
Mailing Address - Fax:
Practice Address - Street 1:2377 PIERCE ST
Practice Address - Street 2:
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46407-3417
Practice Address - Country:US
Practice Address - Phone:219-677-0881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-20
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN44-01-06-05865376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide