Provider Demographics
NPI:1992491013
Name:GILLETTE, VICTORIA KATHLEEN
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:KATHLEEN
Last Name:GILLETTE
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 1:1049 W 3200 N
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-2497
Mailing Address - Country:US
Mailing Address - Phone:801-980-8100
Mailing Address - Fax:
Practice Address - Street 1:1049 W 3200 N
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-2497
Practice Address - Country:US
Practice Address - Phone:801-980-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-12
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2023-ALII-UT000933376G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376G00000XNursing Service Related ProvidersNursing Home Administrator