Provider Demographics
NPI:1235914292
Name:GILLIGAN, HEATHER EILEEN (RN)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:EILEEN
Last Name:GILLIGAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:458 TOWN SQ
Mailing Address - Street 2:
Mailing Address - City:COPPERAS COVE
Mailing Address - State:TX
Mailing Address - Zip Code:76522-2826
Mailing Address - Country:US
Mailing Address - Phone:254-499-8742
Mailing Address - Fax:254-547-9297
Practice Address - Street 1:458 TOWN SQ
Practice Address - Street 2:
Practice Address - City:COPPERAS COVE
Practice Address - State:TX
Practice Address - Zip Code:76522-2826
Practice Address - Country:US
Practice Address - Phone:254-499-8742
Practice Address - Fax:254-547-9297
Is Sole Proprietor?:No
Enumeration Date:2023-08-29
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX849187163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator