Healthcare Provider Details

I. General information

NPI: 1336113273
Provider Name (Legal Business Name): STEFANI D GILSON ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 N DIERS AVE SUITE 300
GRAND ISLAND NE
68803-4958
US

IV. Provider business mailing address

3720 STATE ST APARTMENT I - 9
GRAND ISLAND NE
68803-2377
US

V. Phone/Fax

Practice location:
  • Phone: 308-382-0344
  • Fax:
Mailing address:
  • Phone: 308-390-2800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number300
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: