Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 01067290A | IN |
Y | 208600000X | Surgeon | 01067290A | IN |
N | 2086S0105X | Surgery of the Hand | 37242 | IA |
N | 2086S0122X | Plastic and Reconstructive Surgery | 125-043270 | IL |
N | 2086S0122X | Plastic and Reconstructive Surgery | 37242 | IA |
NPI | 1457573917 |
---|---|
Provider Name | Dr. Jessica Nguyen Gillespie |
First Address | Greenwood, IN 46143-7241 |
Second Address | Indianapolis, IN 46237 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2007 |
Last Update Date | 20/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
70043 | WELLMARK BCBS (01) | IA |