| Doctor Name: | SHELLY J GILLILAND |
| NPI Number: | 1356676126 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | ARNP |
| License Number: | AP60107881 |
| Business Practice Address: | 411 Fortuyn Rd Grand Coulee, WA - 991338718 |
| Business Phone Number: | 5096331753 |
| Business Fax Number: | 5096331930 |
| Mailing Address: | 411 Fortuyn Rd, GRAND COULEE |
| State: | WA |
| Postal Code: | 991338718 |
| Phone Number: | 5096331753 |
| Fax Number: | 5096331930 |
| NPI Enumeration Date: | 10/12/2009 |
| NPI Last Update Date: | 08/06/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | AP60107881 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |