Provider Demographics
NPI:1114784923
Name:GILMORE, CIERRA MICHELLE
Entity Type:Individual
Prefix:
First Name:CIERRA
Middle Name:MICHELLE
Last Name:GILMORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5235 HUTCHISON ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH BLOOMFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:43103-7518
Mailing Address - Country:US
Mailing Address - Phone:740-963-2604
Mailing Address - Fax:
Practice Address - Street 1:5235 HUTCHISON ST
Practice Address - Street 2:
Practice Address - City:SOUTH BLOOMFIELD
Practice Address - State:OH
Practice Address - Zip Code:43103-7518
Practice Address - Country:US
Practice Address - Phone:740-963-2604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-28
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker