Provider Demographics
NPI:1497793061
Name:GILE, GLEE FRANCES (PA-C)
Entity Type:Individual
Prefix:
First Name:GLEE
Middle Name:FRANCES
Last Name:GILE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2930 11TH AVE
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:CO
Mailing Address - Zip Code:80620-1011
Mailing Address - Country:US
Mailing Address - Phone:970-353-9403
Mailing Address - Fax:970-353-9906
Practice Address - Street 1:2930 11TH AVE
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:CO
Practice Address - Zip Code:80620-1011
Practice Address - Country:US
Practice Address - Phone:970-353-9403
Practice Address - Fax:970-353-9906
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2010-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0633363A00000X
WAPA10004485363A00000X
CO814363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO814OtherCOLORADO LICENSE
199380OtherWA L & I
CO33273286Medicaid
6059GLOtherREGENCE BS
WA8355539Medicaid
8906873OtherWA CRIME VICTIMS
WA8355539Medicaid
CO814OtherCOLORADO LICENSE
S54985Medicare UPIN