Provider Demographics
NPI:1821885724
Name:WITHERS, GAITININA (RN)
Entity type:Individual
Prefix:
First Name:GAITININA
Middle Name:
Last Name:WITHERS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:NINA
Other - Middle Name:
Other - Last Name:WITHERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1050 PERAZZO CIR
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-7667
Mailing Address - Country:US
Mailing Address - Phone:916-705-3271
Mailing Address - Fax:
Practice Address - Street 1:10487 WHITE ROCK RD
Practice Address - Street 2:
Practice Address - City:RANCHO CORDOVA
Practice Address - State:CA
Practice Address - Zip Code:95670-5530
Practice Address - Country:US
Practice Address - Phone:916-294-9180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-23
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA825795163WC1500X, 163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health