Healthcare Provider Details

I. General information

NPI: 1033422977
Provider Name (Legal Business Name): NICOLE GAMA R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2010
Last Update Date: 07/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

694 BREEZEWOOD LN
ORWELL OH
44076-8374
US

IV. Provider business mailing address

694 BREEZEWOOD LN
ORWELL OH
44076-8374
US

V. Phone/Fax

Practice location:
  • Phone: 440-437-2009
  • Fax:
Mailing address:
  • Phone: 440-437-2009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN.315576
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number631482
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: