Healthcare Provider Details

I. General information

NPI: 1558266734
Provider Name (Legal Business Name): RENA R. GILLIAM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46 PROGRESS ST
ABINGTON MA
02351-2544
US

IV. Provider business mailing address

46 PROGRESS ST
ABINGTON MA
02351-2544
US

V. Phone/Fax

Practice location:
  • Phone: 617-794-7362
  • Fax:
Mailing address:
  • Phone: 617-794-7362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH1000X
TaxonomyHospice Registered Nurse
License NumberRN2309010
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: