Individual
JACKIE CAROLE GILLILAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN BSN IBCLC
Contact information
Practice address
8237 NW STONEBRIDGE CT, LAWTON, OK 73505-4127
(580) 536-3743
Mailing address
8237 NW STONEBRIDGE CT, LAWTON, OK 73505-4127
(580) 536-3743
Taxonomy
Speciality
Code
Description
License number
State
163WL0100X
Lactation Consultant (Registered Nurse)
Primary
R0027885
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100749570S
—
OK
Enumeration date
01/31/2008
Last updated
06/17/2009
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