Provider Demographics
NPI:1811495971
Name:HILL, GWENDOLYN ANN (NURSING ASSISTANT)
Entity type:Individual
Prefix:
First Name:GWENDOLYN
Middle Name:ANN
Last Name:HILL
Suffix:
Gender:F
Credentials:NURSING ASSISTANT
Other - Prefix:
Other - First Name:GWENDOLYN
Other - Middle Name:ANN
Other - Last Name:HILL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3517 GOLDEN DR. APT C
Mailing Address - Street 2:3517 GOLDEN DR. APT C
Mailing Address - City:CHALMETT
Mailing Address - State:LA
Mailing Address - Zip Code:70043
Mailing Address - Country:US
Mailing Address - Phone:504-296-0328
Mailing Address - Fax:504-962-7364
Practice Address - Street 1:3517 GOLDEN DR. APT C
Practice Address - Street 2:3517 GOLDEN DR. APT C
Practice Address - City:CHALMETT
Practice Address - State:LA
Practice Address - Zip Code:70043
Practice Address - Country:US
Practice Address - Phone:504-296-0328
Practice Address - Fax:504-962-7364
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-24
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LABS4059124K251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health