Provider Demographics
NPI:1487658308
Name:GILL, LISA GAYE (CNP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:GAYE
Last Name:GILL
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SEAGATE STE 800
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-1558
Mailing Address - Country:US
Mailing Address - Phone:567-585-0070
Mailing Address - Fax:567-703-8685
Practice Address - Street 1:6711 AIRPORT HWY
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:OH
Practice Address - Zip Code:43528-8104
Practice Address - Country:US
Practice Address - Phone:567-585-0070
Practice Address - Fax:567-703-8685
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704178651363LF0000X
OHNP-08068363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2540843Medicaid
MI1487658308Medicaid
OHNP08068OtherSTATE OHIO NP