Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 2015004617 | OH |
NPI | 1043695976 |
---|---|
Provider Name | Crystal Gilligan |
First Address | Milford, OH 45150-2010 |
Second Address | Dayton, OH 45409-2939 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2015 |
Last Update Date | 18/08/2015 |