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Gateway Medical Staffing
9270 Olive Boulevard
St. Louis, MO 63132
Phone: 314-993-6800
Fax: 314-993-8799
Toll Free: 1-877-993-6800

Healthcare Provider's Profile

(RNs, LPNs, CNAs, CMTs, Home Health Aides, NAs, Respiratory Therapist)

Employee Name:

Email:

Title:
Address:
City:
State:
Zip Code:
Phone:
Fax:
License/Certificate Number:
State:
Expiration Date:

Areas of Expertise:

(Please indicate experience in months and years)
Private Duty: Years Months
Adult Day Care: Years Months
Nursing Home: Years Months
Children's Home: Years Months
Clinics: Years Months
Home Health: Years Months
Occupational/Industrial: Years Months
Correctional Facilities: Years Months
Quality Assurance: Years Months
Utilization Review: Years Months
Case Manager: Years Months
Hospice: Years Months
Dialysis Center: Years Months
Doctor's Office: Years Months
Other:

Hospital Experience:

(Please indicate experience in months and years)
Med/Surgery: Years Months
Ortho: Years Months
OR: Years Months
ER: Years Months
ICU/CCU/SICU: Years Months
Peds: Years Months
Neuro: Years Months
Rehab: Years Months
Oncology: Years Months
Telemetry: Years Months
Psych: Years Months
Nursery: Years Months
NICU: Years Months
Nephrology: Years Months
Chem Depend: Years Months
Recovery Room: Years Months
Geriatrics: Years Months
Other:



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