Provider Demographics
NPI:1750704029
Name:GOMILLER, FRANCES (LPN)
Entity type:Individual
Prefix:
First Name:FRANCES
Middle Name:
Last Name:GOMILLER
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 1:374 COUNTY ROAD 48
Mailing Address - Street 2:
Mailing Address - City:VAIDEN
Mailing Address - State:MS
Mailing Address - Zip Code:39176-5047
Mailing Address - Country:US
Mailing Address - Phone:662-508-5108
Mailing Address - Fax:662-508-5109
Practice Address - Street 1:104 S FRONT ST
Practice Address - Street 2:
Practice Address - City:WINONA
Practice Address - State:MS
Practice Address - Zip Code:38967-2544
Practice Address - Country:US
Practice Address - Phone:662-508-5108
Practice Address - Fax:662-508-5109
Is Sole Proprietor?:No
Enumeration Date:2014-01-22
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSP277002164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse