| NPI | 1376879189 |
|---|---|
| Former Name | REBEL RENEA GILLENWATER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WV 62507-RN 2009007356) |
| Enumeration Date | 2009-10-29 |
| Last Update Date | 2013-04-15 |