# MRS. MARTHA JANE GILLIAM

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1578549333
- **Gender:** F
- **Credential:** ANP-BC

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 163W00000X | Registered Nurse | RN053744 | AZ | — |
| 363LA2200X | Adult Health Nurse Practitioner | AP0273 | AZ | — |
| 363LA2200X | Adult Health Nurse Practitioner | AP7115 | AZ | Yes |
| 363LA2200X | Adult Health Nurse Practitioner | RN053744 | AZ | — |

## Other

- **Enumeration date:** 12/22/2005
- **Last updated:** 09/16/2021