MEDICARE: LORRAINE TAYLOR GILLEY FNP-C

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	83780	CO

General Provider Information

NPI Number	:	1932256013
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORRAINE TAYLOR GILLEY FNP-C

Provider Business Mailing Address
First Line	:	18285 TABLE ROCK RD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80908-1520
Country	:	US
Telephone Number	:	719-495-1018
Fax Number	:

Provider Business Practice Location Address
First Line	:	3190 E LAS VEGAS ST
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80906-8002
Country	:	US
Telephone Number	:	719-390-2735
Fax Number	:

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

Provider Enumeration Date	:	01/04/2007
Last Update Date	:	07/08/2007

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