Provider Demographics
NPI:1225321383
Name:NANCY GILLIAM L.AC. LLC
Entity Type:Organization
Organization Name:NANCY GILLIAM L.AC. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:D
Authorized Official - Last Name:GILLIAM
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:520-886-5122
Mailing Address - Street 1:PO BOX 19166
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85731-9166
Mailing Address - Country:US
Mailing Address - Phone:520-886-5122
Mailing Address - Fax:520-886-5195
Practice Address - Street 1:7225 N PASEO DEL NORTE
Practice Address - Street 2:#5
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-4412
Practice Address - Country:US
Practice Address - Phone:520-886-5122
Practice Address - Fax:520-886-5195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-24
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service