Healthcare Provider Details

I. General information

NPI: 1578267407
Provider Name (Legal Business Name): AMELIA HELEN GILLILAND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1525 W 5TH ST
STORM LAKE IA
50588-3027
US

IV. Provider business mailing address

7 TIMBERWOOD DR UNIT 119
LEBANON NH
03766-4470
US

V. Phone/Fax

Practice location:
  • Phone: 712-732-4030
  • Fax:
Mailing address:
  • Phone: 907-231-2587
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberDO-55846
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: