Provider Demographics
NPI:1134594526
Name:GILL, RAJWANT K I
Entity type:Individual
Prefix:MRS
First Name:RAJWANT
Middle Name:K
Last Name:GILL
Suffix:I
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 1:1812 HARDIAL DR
Mailing Address - Street 2:
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95993-9429
Mailing Address - Country:US
Mailing Address - Phone:530-301-7611
Mailing Address - Fax:
Practice Address - Street 1:995 SPRUCE AVE
Practice Address - Street 2:
Practice Address - City:GRIDLEY
Practice Address - State:CA
Practice Address - Zip Code:95948
Practice Address - Country:US
Practice Address - Phone:530-301-7611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-10
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA241146164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse