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NPI Code Detail

MEDICARE: MRS. CATELYN GILLIS CPNP-AC

MEDICARE: MRS. CATELYN GILLIS CPNP-AC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse Practitioner4704292993MI
2363LP0222XCritical Care Pediatric Nurse PractitionerCOA.18475-NPOH

General Provider Information

NPI Number : 1326405275
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. CATELYN GILLIS CPNP-AC
Provider Business Mailing Address
First Line : 11100 EUCLID AVE
Second Line :
City : CLEVELAND
State : OH
Zip : 44106-1716
Country : US
Telephone Number : 216-844-7700
Fax Number :
Provider Business Practice Location Address
First Line : 11100 EUCLID AVE STE 380
Second Line :
City : CLEVELAND
State : OH
Zip : 44106-1716
Country : US
Telephone Number : 216-286-5899
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/23/2016
Last Update Date : 09/29/2022

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