Provider Demographics
NPI:1407862204
Name:GILLETT, PATRICIA HELEN (NP)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:HELEN
Last Name:GILLETT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3821 MASTHEAD ST NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-4679
Mailing Address - Country:US
Mailing Address - Phone:505-998-7400
Mailing Address - Fax:505-998-7741
Practice Address - Street 1:3821 MASTHEAD ST NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-4679
Practice Address - Country:US
Practice Address - Phone:505-998-7400
Practice Address - Fax:505-998-7741
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR17433363LF0000X
NMCNP00233363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMP35813Medicare UPIN