Healthcare Provider Details

I. General information

NPI: 1942566021
Provider Name (Legal Business Name): LAUREN NICOLE GILL FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2012
Last Update Date: 02/17/2021
Certification Date: 02/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

955 N MICHIGAN AVE STE 81
GREENSBURG IN
47240-1487
US

IV. Provider business mailing address

801 YORK ST
MANITOWOC WI
54220-4630
US

V. Phone/Fax

Practice location:
  • Phone: 812-222-0202
  • Fax: 812-222-0104
Mailing address:
  • Phone: 866-630-9882
  • Fax: 920-682-5810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71003922A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: