Individual
MANYA GORDON GILLIES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
130 FISHER RD, BERLIN, VT 05602-9516
(802) 371-4100
Mailing address
130 FISHER RD, BERLIN, VT 05602-9516
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
101.0137162
VT
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/29/2024
Last updated
10/28/2024
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