Provider Demographics
NPI:1336113273
Name:GILSON, STEFANI D (ATC)
Entity Type:Individual
Prefix:MRS
First Name:STEFANI
Middle Name:D
Last Name:GILSON
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3720 STATE ST
Mailing Address - Street 2:APARTMENT I - 9
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-2377
Mailing Address - Country:US
Mailing Address - Phone:308-390-2800
Mailing Address - Fax:
Practice Address - Street 1:620 N DIERS AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-4958
Practice Address - Country:US
Practice Address - Phone:308-382-0344
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer