Provider Demographics
NPI:1023613015
Name:GILLIS, BATAVIA ANTONETTE (RN)
Entity type:Individual
Prefix:
First Name:BATAVIA
Middle Name:ANTONETTE
Last Name:GILLIS
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 1:14765 GALLANT LN
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20601-5516
Mailing Address - Country:US
Mailing Address - Phone:240-784-0506
Mailing Address - Fax:
Practice Address - Street 1:14765 GALLANT LN
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20601-5516
Practice Address - Country:US
Practice Address - Phone:240-784-0506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-30
Last Update Date:2020-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR167761163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health