Healthcare Provider Details

I. General information

NPI: 1851230155
Provider Name (Legal Business Name): GAYLE M GILLISPIE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2026
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 S 18TH PLZ
OMAHA NE
68102-2077
US

IV. Provider business mailing address

11006 S 15TH ST APT 105
BELLEVUE NE
68123-4504
US

V. Phone/Fax

Practice location:
  • Phone: 402-996-3545
  • Fax:
Mailing address:
  • Phone: 402-996-3574
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number52956
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: