Healthcare Provider Details

I. General information

NPI: 1679493761
Provider Name (Legal Business Name): MARIA GILLIES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 07/17/2026
Certification Date: 07/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 S BLUFF ST STE 4
SAINT GEORGE UT
84770-5236
US

IV. Provider business mailing address

1102 SHADOW POINT DR
SAINT GEORGE UT
84770-8038
US

V. Phone/Fax

Practice location:
  • Phone: 435-500-6734
  • Fax:
Mailing address:
  • Phone: 435-730-6040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number7703060-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: