Provider Demographics
NPI:1427215078
Name:GILLILAND, KATHRYN JANE (RN)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:JANE
Last Name:GILLILAND
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 1:3400 W 66TH ST
Mailing Address - Street 2:SUITE 150
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-2109
Mailing Address - Country:US
Mailing Address - Phone:952-920-7200
Mailing Address - Fax:952-920-1708
Practice Address - Street 1:3400 W 66TH ST
Practice Address - Street 2:SUITE 150
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2109
Practice Address - Country:US
Practice Address - Phone:952-920-7200
Practice Address - Fax:952-920-1708
Is Sole Proprietor?:No
Enumeration Date:2008-05-21
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR-080283-9163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse