Provider Demographics
NPI:1437622388
Name:GILLEN, ANDY
Entity Type:Individual
Prefix:
First Name:ANDY
Middle Name:
Last Name:GILLEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 E PARK AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-4657
Mailing Address - Country:US
Mailing Address - Phone:210-227-9494
Mailing Address - Fax:
Practice Address - Street 1:201 E PARK AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-4657
Practice Address - Country:US
Practice Address - Phone:210-227-9494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-03
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion