Provider Demographics
NPI:1285332965
Name:GULLICKSON, ELEANORA ROSE (RN)
Entity type:Individual
Prefix:
First Name:ELEANORA
Middle Name:ROSE
Last Name:GULLICKSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4258 TELEGRAPH RD
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-3706
Mailing Address - Country:US
Mailing Address - Phone:818-280-7630
Mailing Address - Fax:
Practice Address - Street 1:4258 TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-3706
Practice Address - Country:US
Practice Address - Phone:805-477-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-21
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN95254767163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse