Provider Demographics
NPI:1154596260
Name:DEJARNETTE, GAYNELL
Entity type:Individual
Prefix:MS
First Name:GAYNELL
Middle Name:
Last Name:DEJARNETTE
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 1:2002 GOLDEN LEAF RD
Mailing Address - Street 2:
Mailing Address - City:NATHALIE
Mailing Address - State:VA
Mailing Address - Zip Code:24577-3492
Mailing Address - Country:US
Mailing Address - Phone:434-349-2391
Mailing Address - Fax:501-639-4397
Practice Address - Street 1:2002 GOLDEN LEAF RD
Practice Address - Street 2:
Practice Address - City:NATHALIE
Practice Address - State:VA
Practice Address - Zip Code:24577-3492
Practice Address - Country:US
Practice Address - Phone:434-349-2391
Practice Address - Fax:501-639-4397
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA8193747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider