Individual
MS. JOHNETTE KAYE GILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
R.N.
Contact information
Practice address
12033 AGENCY RD, PARKER, AZ 85344-7718
(928) 669-2137
Mailing address
3005 GATEWOOD DR, LAKE HAVASU CITY, AZ 86404-3352
(928) 594-3090
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
R34837
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
R34837
STATE LICENSE
ND
Enumeration date
08/10/2010
Last updated
08/10/2010
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