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General NPI Number Information
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NPI Number | 1043695976
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Entity Type | Individual
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Provider Name | CRYSTAL GILLIGAN
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Gender | Female
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Dates
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Enumeration Date | 07/21/2015
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Last Update Date | 08/18/2015
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Provider Practice Location Address
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Address Line | 30 E APPLE ST SUITE 5254A
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City | DAYTON
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State | OH
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Zip | 45409-2939
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Country | US
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Telephone | 937-208-4200
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Fax |
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Provider Business Mailing Address
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Address Line | 1079 RAINBOW TRL
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City | MILFORD
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State | OH
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Zip | 45150-2010
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Country | US
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Telephone | 513-479-0808
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 2015004617
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License Number State | OH
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