Provider Demographics
NPI:1134468168
Name:GILDOW, JUSTIN PAUL (FNP-BC)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:PAUL
Last Name:GILDOW
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 E COLUMBUS AVE
Mailing Address - Street 2:
Mailing Address - City:BELLEFONTAINE
Mailing Address - State:OH
Mailing Address - Zip Code:43311-2033
Mailing Address - Country:US
Mailing Address - Phone:937-599-1411
Mailing Address - Fax:937-599-4128
Practice Address - Street 1:212 E COLUMBUS AVE
Practice Address - Street 2:
Practice Address - City:BELLEFONTAINE
Practice Address - State:OH
Practice Address - Zip Code:43311-2033
Practice Address - Country:US
Practice Address - Phone:937-599-1411
Practice Address - Fax:937-599-4128
Is Sole Proprietor?:No
Enumeration Date:2013-02-12
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH14031363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0101752Medicaid
OH14031OtherLICENSE NUMBER
OHH183851Medicare PIN