Basic Information
| Provider Information | |||||||||
| NPI: | 1225708241 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GAINEY | ||||||||
| FirstName: | NICOLE | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11874 BEVERLY JEAN RD | ||||||||
| Address2: | |||||||||
| City: | STURGIS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 577856963 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6056452423 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2450 ORO DAM BLVD E | ||||||||
| Address2: | |||||||||
| City: | OROVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 959666052 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5307122171 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2021 | ||||||||
| LastUpdateDate: | 09/20/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/20/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.