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Individual
TERRY GILLEN
Active
Individual
TERRY GILLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
619883
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
619883
MEDICAID/MEDICARE
NY
05
—
619883
—
NY
05
—
N02148756
—
NY
Enumeration date
02/27/2019
Last updated
02/27/2019
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