Provider Demographics
NPI:1063649861
Name:GILLEY, CRISTIN AUTREY (CNM)
Entity Type:Individual
Prefix:
First Name:CRISTIN
Middle Name:AUTREY
Last Name:GILLEY
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:CRISTIN
Other - Middle Name:ELIZABETH
Other - Last Name:AUTREY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2003 MEDICAL PKWY
Mailing Address - Street 2:SUITE G50
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-7992
Mailing Address - Country:US
Mailing Address - Phone:410-573-1094
Mailing Address - Fax:410-573-1097
Practice Address - Street 1:2003 MEDICAL PKWY
Practice Address - Street 2:SUITE G50
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-7992
Practice Address - Country:US
Practice Address - Phone:410-573-1094
Practice Address - Fax:410-573-1097
Is Sole Proprietor?:No
Enumeration Date:2009-06-18
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD417732100Medicaid
160144Y5ZMedicare PIN