Most Relevant Information
Provider Data
| NPI Number: | 1003057290 |
| Provider Name: | JESSICA DAWN GULLETTE LPN |
| Entity Type: | Individual |
| Taxonomy Code: | 164W00000X |
| Specialty: | Licensed Practical Nurse |
| License Number: | PN105893 |
Most Important Dates
| Enumeration Date: | 03/17/2009 |
| Last Updated: | 03/17/2009 |
Provider Practice Location
852 E MCCREIGHT AVE
SPRINGFIELD
OH
455033438
Practice Location Phone/Fax
| Phone: | 9376293771 |
| Fax: |
Provider Mailing Location
852 E MCCREIGHT AVE
SPRINGFIELD
OH
455033438
Provider Mailing Phone/Fax
| Phone: | 9376293771 |
| Fax: |