Healthcare Provider Details

I. General information

NPI: 1952164709
Provider Name (Legal Business Name): MRS. AMY LAM GILLIGAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2024
Last Update Date: 09/18/2024
Certification Date: 09/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 MOUNT PLEASANT RD STE A
CHESAPEAKE VA
23322-4155
US

IV. Provider business mailing address

2120 CHESTERFIELD LOOP
CHESAPEAKE VA
23323-6668
US

V. Phone/Fax

Practice location:
  • Phone: 757-312-9444
  • Fax: 757-447-3500
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024190904
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: