Provider Demographics
NPI:1477884864
Name:GILLEY, VENUS ALICIA (MS, RD, LD)
Entity Type:Individual
Prefix:MS
First Name:VENUS
Middle Name:ALICIA
Last Name:GILLEY
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 HIGHLAND AVE
Mailing Address - Street 2:APT. 1
Mailing Address - City:GARDINER
Mailing Address - State:ME
Mailing Address - Zip Code:04345-1803
Mailing Address - Country:US
Mailing Address - Phone:207-557-9020
Mailing Address - Fax:
Practice Address - Street 1:89 HIGHLAND AVE
Practice Address - Street 2:APT. 1
Practice Address - City:GARDINER
Practice Address - State:ME
Practice Address - Zip Code:04345-1803
Practice Address - Country:US
Practice Address - Phone:207-557-9020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-25
Last Update Date:2010-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDI1004133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered