Provider Demographics
NPI:1043078801
Name:GILL, MIKAELA (APRN)
Entity Type:Individual
Prefix:
First Name:MIKAELA
Middle Name:
Last Name:GILL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:757 S 17TH ST UNIT 3
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19146-2002
Mailing Address - Country:US
Mailing Address - Phone:913-948-0032
Mailing Address - Fax:
Practice Address - Street 1:757 S 17TH ST UNIT 3
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19146-2002
Practice Address - Country:US
Practice Address - Phone:913-948-0032
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-07
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN10001160363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily