Provider Demographics
NPI:1083028674
Name:CROTEAU, GILLIAN M (PA)
Entity Type:Individual
Prefix:
First Name:GILLIAN
Middle Name:M
Last Name:CROTEAU
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:74 LUNT RD STE 204
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04105-1996
Mailing Address - Country:US
Mailing Address - Phone:207-709-0939
Mailing Address - Fax:207-514-8213
Practice Address - Street 1:74 LUNT RD STE 204
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04105-1996
Practice Address - Country:US
Practice Address - Phone:207-709-0939
Practice Address - Fax:207-514-8213
Is Sole Proprietor?:No
Enumeration Date:2014-06-11
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical