Healthcare Provider Details

I. General information

NPI: 1922375849
Provider Name (Legal Business Name): /C. MARGO GILMAN REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2011
Last Update Date: 11/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

149 ROUTE 245
RUSHVILLE NY
14544-9692
US

IV. Provider business mailing address

149 ROUTE 245
RUSHVILLE NY
14544-9692
US

V. Phone/Fax

Practice location:
  • Phone: 585-554-4806
  • Fax: 585-554-6172
Mailing address:
  • Phone: 585-554-4806
  • Fax: 585-554-6172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number318984-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: