Provider Demographics
NPI:1316498025
Name:GILBERT, NICOLE
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:GILBERT
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 1:4001 HAYES ST NE
Mailing Address - Street 2:APT 15
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019-3557
Mailing Address - Country:US
Mailing Address - Phone:347-854-6732
Mailing Address - Fax:
Practice Address - Street 1:4001 HAYES ST NE
Practice Address - Street 2:APT 15
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-3557
Practice Address - Country:US
Practice Address - Phone:347-854-6732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-18
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA12281374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide