Healthcare Provider Details

I. General information

NPI: 1376674861
Provider Name (Legal Business Name): GILLIAN MARY MCKIE APNC- NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 01/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 ROBERT WOOD JOHNSON PLACE
NEW BRUNSWICK NJ
08903
US

IV. Provider business mailing address

120 ALBANY STREET TOWER 2, 7TH FLOOR
NEW BRUNSWICK NJ
08901-2126
US

V. Phone/Fax

Practice location:
  • Phone: 732-235-7840
  • Fax: 732-235-7048
Mailing address:
  • Phone: 732-937-8537
  • Fax: 732-937-8941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberMA051658
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number26NJ00021100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: