Individual
JENIFER T. GILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1812 S J ST, TACOMA, WA 98405-4964
(253) 752-6965
Mailing address
1145 BROADWAY FL 2, SEATTLE, WA 98122-4201
(206) 329-1760
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA10002657
WA
363AM0700X
Medical Physician Assistant
PA10002657
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1215078050
—
WA
Enumeration date
02/12/2007
Last updated
11/05/2021
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