Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 42885 | MN |
N | 2084N0400X | Neurologist | 42885 | MN |
Y | 2084N0402X | Child Neurologist | 42885 | MN |
NPI | 1376647636 |
---|---|
Provider Name | Elizabeth E Gilles |
First Address | Saint Paul, MN 55102-2564 |
Second Address | Saint Paul, MN 55102-2564 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/09/2006 |
Last Update Date | 18/03/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
849640400 | (05) | MN |
E71853 | (02) |