MEDICARE: GILEAD HEALTH SERVICES LLC

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
1	363LF0000X	Family Nurse Practitioner

General Provider Information

NPI Number	:	1871162727
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GILEAD HEALTH SERVICES LLC

Provider Business Mailing Address
First Line	:	9722 GROFFS MILL DR
Second Line	:
City	:	OWINGS MILLS
State	:	MD
Zip	:	21117-6341
Country	:	US
Telephone Number	:	410-989-1944
Fax Number	:	570-507-8268

Provider Business Practice Location Address
First Line	:	22 W PADONIA RD STE C252
Second Line	:
City	:	LUTHERVILLE TIMONIUM
State	:	MD
Zip	:	21093-2241
Country	:	US
Telephone Number	:	410-989-1944
Fax Number	:	570-507-8268

Authorized Official
Title or Position	:	OWNER OF ENTITY
Name	:	PROMISE C ALLAN
Credential	:	MSN, CRNP-FAMILY
Telephone Number	:	410-898-1944

Provider Enumeration Date	:	06/23/2021
Last Update Date	:	06/23/2021

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