Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 0101240253 | VA |
NPI | 1063474336 |
---|---|
Provider Name | Theresa Mary Gille |
First Address | Camp Lejeune, NC 28547-2538 |
Second Address | Camp Lejeune, NC 28547-2538 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2006 |
Last Update Date | 04/06/2019 |