Individual
AUDRIA GILLILAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
52101 34TH AVENUE, BANGOR, MI 49013
(269) 427-5671
Mailing address
PO BOX 177, BANGOR, MI 49013-0177
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
4704345377
MI
Other
Enumeration date
07/31/2019
Last updated
12/26/2019
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