Doctor Name: | SUSAN GILILLAND |
NPI Number: | 1043534571 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 18993 |
Business Practice Address: | 850 E Latham Ave Suite 204 Hemet, CA - 925434391 |
Business Phone Number: | 9516526522 |
Business Fax Number: | |
Mailing Address: | 740 Mazana Dr, HEMET |
State: | CA |
Postal Code: | 925431762 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 03/26/2010 |
NPI Last Update Date: | 03/26/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 18993 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |