Provider Demographics
NPI:1831731488
Name:VAN GILDER, EMMA ROSE
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:ROSE
Last Name:VAN GILDER
Suffix:
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 1:223 PAYNE BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:BLOWING ROCK
Mailing Address - State:NC
Mailing Address - Zip Code:28605-9021
Mailing Address - Country:US
Mailing Address - Phone:828-773-2676
Mailing Address - Fax:
Practice Address - Street 1:223 PAYNE BRANCH RD
Practice Address - Street 2:
Practice Address - City:BLOWING ROCK
Practice Address - State:NC
Practice Address - Zip Code:28605-9021
Practice Address - Country:US
Practice Address - Phone:828-773-2676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-15
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC385H00000X, 372600000X
253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No385H00000XRespite Care FacilityRespite Care
No372600000XNursing Service Related ProvidersAdult Companion