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NPI Code Detail

MEDICARE: REBECCA GILLILAN CNIM

MEDICARE:   REBECCA  GILLILAN  CNIM
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1246ZE0600XElectroneurodiagnostic Specialist/Technologist1640
2235Z00000XSpeech-Language PathologistNV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11640OTHERCNIM

General Provider Information

NPI Number : 1023291754
Entity Type Code : Individual
Provider Name (Legal Business Name) : REBECCA GILLILAN CNIM
Provider Business Mailing Address
First Line : 4080 N JULIANO RD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89129-0401
Country : US
Telephone Number : 702-883-9401
Fax Number :
Provider Business Practice Location Address
First Line : 4080 N JULIANO RD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89129-0401
Country : US
Telephone Number : 702-883-9401
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/17/2007
Last Update Date : 03/16/2026

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Directions to “ REBECCA GILLILAN CNIM” Practice Location

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