Healthcare Provider Details

I. General information

NPI: 1023780491
Provider Name (Legal Business Name): PHYLLIS GILL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2021
Last Update Date: 10/04/2021
Certification Date: 10/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13807 UNION AVE
CLEVELAND OH
44120-4520
US

IV. Provider business mailing address

13807 UNION AVE
CLEVELAND OH
44120-4520
US

V. Phone/Fax

Practice location:
  • Phone: 216-482-0152
  • Fax:
Mailing address:
  • Phone: 216-482-0152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number401761070615
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: