Provider Demographics
NPI:1437202678
Name:GILLILAND, MARLENE MAY (CMA)
Entity Type:Individual
Prefix:
First Name:MARLENE
Middle Name:MAY
Last Name:GILLILAND
Suffix:
Gender:F
Credentials:CMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1424 S 25TH AVE
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-5100
Mailing Address - Country:US
Mailing Address - Phone:509-457-3622
Mailing Address - Fax:
Practice Address - Street 1:408 BUSTER ROAD
Practice Address - Street 2:
Practice Address - City:TOPPENISH
Practice Address - State:WA
Practice Address - Zip Code:98958
Practice Address - Country:US
Practice Address - Phone:509-865-2102
Practice Address - Fax:509-865-1729
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAHC00148288247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other