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General NPI Number Information
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NPI Number | 1578428116
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Entity Type | Organization
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Legal Business Name | LUCINDA KIL GILLIS LLC
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Dates
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Enumeration Date | 12/17/2025
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Last Update Date | 12/17/2025
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Provider Practice Location Address
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Address Line | 17434 STATE ROAD 23
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City | SOUTH BEND
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State | IN
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Zip | 46635-1743
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Country | US
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Telephone | 574-272-6406
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Fax | 464-333-9684
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Provider Business Mailing Address
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Address Line | 17434 STATE ROAD 23
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City | SOUTH BEND
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State | IN
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Zip | 46635-1743
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Country | US
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Telephone | 574-272-6406
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Fax | 464-333-9684
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | LUCINDA KIL GILLIS
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Credential | APRN, PMHNP-BC
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Telephone | 574-329-0241
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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