=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952200842
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALICIA SUE GILLIS RN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/05/2026
-----------------------------------------------------
Last Update Date | 11/05/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 101 BOULDER POINT DR STE 1
-----------------------------------------------------
City | PLYMOUTH
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03264-3170
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-832-1119
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 101 BOULDER POINT DR STE 1
-----------------------------------------------------
City | PLYMOUTH
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03264-3170
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-832-1119
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | 073634-21
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------