Healthcare Provider Details

I. General information

NPI: 1780836148
Provider Name (Legal Business Name): JENNIFER GILLIS N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2008
Last Update Date: 03/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

277 PLEASANT ST STE. 309
FALL RIVER MA
02721-3005
US

IV. Provider business mailing address

277 PLEASANT ST STE. 309
FALL RIVER MA
02721-3005
US

V. Phone/Fax

Practice location:
  • Phone: 508-676-3292
  • Fax:
Mailing address:
  • Phone: 508-676-3292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number214381
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: