Healthcare Provider Details

I. General information

NPI: 1598904336
Provider Name (Legal Business Name): JENNIFER EILEEN GILLIATT N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2009
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 SECOND AVE STE 1110
WALTHAM MA
02451-1129
US

IV. Provider business mailing address

52 SECOND AVE STE 1110
WALTHAM MA
02451-1129
US

V. Phone/Fax

Practice location:
  • Phone: 781-487-6212
  • Fax:
Mailing address:
  • Phone: 781-487-6212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN274528
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN274528
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberRN274528
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: