Provider Demographics
NPI:1457688251
Name:GULLETT, NANCY KAY (LPN)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:KAY
Last Name:GULLETT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 ARIZONA AVE
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN FURNACE
Mailing Address - State:OH
Mailing Address - Zip Code:45629
Mailing Address - Country:US
Mailing Address - Phone:740-355-4024
Mailing Address - Fax:
Practice Address - Street 1:45 ARIZONA AVE
Practice Address - Street 2:
Practice Address - City:FRANKLIN FURNACE
Practice Address - State:OH
Practice Address - Zip Code:45629
Practice Address - Country:US
Practice Address - Phone:740-355-4024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-16
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH133898164W00000X
KY2043763164W00000X
WV30270164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse