Basic Information
| Provider Information | |||||||||
| NPI: | 1306481932 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GADDIE | ||||||||
| FirstName: | JEAN | ||||||||
| MiddleName: | NELSON | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2708 GREENHILL DR | ||||||||
| Address2: | |||||||||
| City: | JEFFERSONVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 471306622 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5025991544 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1700 CARGO CT | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402991938 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5027496764 | ||||||||
| FaxNumber: | 5027496843 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2019 | ||||||||
| LastUpdateDate: | 11/07/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 1088639 | KY | Y | Nursing Service Providers | Registered Nurse |
No ID Information.