MEDICARE: LISA GAYE GILL CNP

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
1	363LF0000X	Family Nurse Practitioner	4704178651	MI
2	363LF0000X	Family Nurse Practitioner	NP-08068	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	NP08068	OTHER	OH	STATE OHIO NP

General Provider Information

NPI Number	:	1487658308
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA GAYE GILL CNP

Provider Business Mailing Address
First Line	:	100 MADISON AVE
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43604-1516
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2150 W CENTRAL AVE
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43606-3834
Country	:	US
Telephone Number	:	419-291-8701
Fax Number	:	419-479-3298

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	07/19/2024

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