Healthcare Provider Details

I. General information

NPI: 1558484089
Provider Name (Legal Business Name): CHRISTINA M GILLETTE NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 09/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11725 N ILLINOIS ST SUITE 350
CARMEL IN
46032-3008
US

IV. Provider business mailing address

11725 N ILLINOIS ST SUITE 350
CARMEL IN
46032-3008
US

V. Phone/Fax

Practice location:
  • Phone: 317-814-4696
  • Fax: 317-814-4699
Mailing address:
  • Phone: 317-814-4696
  • Fax: 317-814-4699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number060698
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: