Provider Demographics
NPI:1053867655
Name:HOLCOMB, GAYLE BUSH (RN)
Entity type:Individual
Prefix:MRS
First Name:GAYLE
Middle Name:BUSH
Last Name:HOLCOMB
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3634 MASON RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON
Mailing Address - State:GA
Mailing Address - Zip Code:30187-1578
Mailing Address - Country:US
Mailing Address - Phone:404-408-7186
Mailing Address - Fax:
Practice Address - Street 1:720 WOOD STREET
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-4413
Practice Address - Country:US
Practice Address - Phone:707-268-2990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95085559163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse