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NPI Code Detail

MEDICARE: MS. KATHLEEN JAN GILLIS RN MSN FNP

MEDICARE: MS. KATHLEEN JAN GILLIS RN MSN FNP
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
1163W00000XRegistered NurseRN289570CA
2363LF0000XFamily Nurse Practitioner7266CA

General Provider Information

NPI Number : 1750354882
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. KATHLEEN JAN GILLIS RN MSN FNP
Provider Business Mailing Address
First Line : 3100 TELEGRAPH AVE
Second Line : SUITE 2102
City : OAKLAND
State : CA
Zip : 94609-3210
Country : US
Telephone Number : 510-286-8160
Fax Number : 510-286-8158
Provider Business Practice Location Address
First Line : 2950 INTERNATIONAL BLVD
Second Line :
City : OAKLAND
State : CA
Zip : 94601-2228
Country : US
Telephone Number : 510-535-4400
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/09/2006
Last Update Date : 06/17/2025

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