Provider Demographics
NPI:1548520653
Name:GILLETTE, RHONDA O
Entity type:Individual
Prefix:
First Name:RHONDA
Middle Name:O
Last Name:GILLETTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:RHONDA
Other - Middle Name:
Other - Last Name:OWENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4325 W ROME BLVD
Mailing Address - Street 2:#3197
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89084-5497
Mailing Address - Country:US
Mailing Address - Phone:702-409-8155
Mailing Address - Fax:
Practice Address - Street 1:4325 W ROME BLVD
Practice Address - Street 2:#3197
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89084-5497
Practice Address - Country:US
Practice Address - Phone:702-409-8155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-22
Last Update Date:2013-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV225400000XOtherREHABILITATION PRACTITIONER