Healthcare Provider Details

I. General information

NPI: 1184829186
Provider Name (Legal Business Name): JOANNE KALEILEHUA GILLEY RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2602 J ST
OMAHA NE
68107-1643
US

IV. Provider business mailing address

803 CODY CIR
PAPILLION NE
68046-3747
US

V. Phone/Fax

Practice location:
  • Phone: 402-733-1325
  • Fax: 402-733-3487
Mailing address:
  • Phone: 402-932-0233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number1873
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: