Provider Demographics
NPI:1750084869
Name:GILL, STEPHANIE COE (OWNER)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:COE
Last Name:GILL
Suffix:
Gender:F
Credentials:OWNER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1135 KILDAIRE FARM RD STE 311-7
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-7608
Mailing Address - Country:US
Mailing Address - Phone:919-321-1155
Mailing Address - Fax:919-214-9207
Practice Address - Street 1:1135 KILDAIRE FARM RD STE 311-7
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-7608
Practice Address - Country:US
Practice Address - Phone:919-321-1155
Practice Address - Fax:919-214-9207
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC5581374U00000X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No374U00000XNursing Service Related ProvidersHome Health Aide