Provider Demographics
NPI:1407494040
Name:GASKINS, MICHELE RENEE (RN)
Entity type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:RENEE
Last Name:GASKINS
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 1:208 OSPREY LN
Mailing Address - Street 2:
Mailing Address - City:HOPKINS
Mailing Address - State:SC
Mailing Address - Zip Code:29061-9498
Mailing Address - Country:US
Mailing Address - Phone:803-873-2501
Mailing Address - Fax:
Practice Address - Street 1:240 N LEO RD
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:SC
Practice Address - Zip Code:29560-6833
Practice Address - Country:US
Practice Address - Phone:803-816-0284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-13
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC211048163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse