Provider Demographics
NPI:1235721952
Name:GILLEN, PAMELA LU (ND,RN,CNS)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:LU
Last Name:GILLEN
Suffix:
Gender:F
Credentials:ND,RN,CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 N 6TH ST
Mailing Address - Street 2:
Mailing Address - City:CANON CITY
Mailing Address - State:CO
Mailing Address - Zip Code:81212-3329
Mailing Address - Country:US
Mailing Address - Phone:719-221-1414
Mailing Address - Fax:
Practice Address - Street 1:121 N 6TH ST
Practice Address - Street 2:
Practice Address - City:CANON CITY
Practice Address - State:CO
Practice Address - Zip Code:81212-3329
Practice Address - Country:US
Practice Address - Phone:719-221-1414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-04
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0106726163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health