Provider Demographics
NPI:1932513025
Name:GULLETT, KAREN GRACE (RN)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:GRACE
Last Name:GULLETT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 EAST NINTH AVE
Mailing Address - Street 2:SIERRA VISTA HOSPITAL
Mailing Address - City:TRUTH OR CONSEQUENCES
Mailing Address - State:NM
Mailing Address - Zip Code:87901
Mailing Address - Country:US
Mailing Address - Phone:575-743-1205
Mailing Address - Fax:575-894-7659
Practice Address - Street 1:800 EAST NINTH AVE
Practice Address - Street 2:SIERRA VISTA HOSPITAL
Practice Address - City:TRUTH OR CONSEQUENCES
Practice Address - State:NM
Practice Address - Zip Code:87901
Practice Address - Country:US
Practice Address - Phone:575-743-1205
Practice Address - Fax:575-894-7659
Is Sole Proprietor?:No
Enumeration Date:2014-06-17
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR37727163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse