Provider Demographics
NPI:1508276882
Name:WILLSON, GILLIAN (RN)
Entity Type:Individual
Prefix:
First Name:GILLIAN
Middle Name:
Last Name:WILLSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:542 OCEAN ST
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-6622
Mailing Address - Country:US
Mailing Address - Phone:831-459-0444
Mailing Address - Fax:
Practice Address - Street 1:941 EL DORADO AVE
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95062-2863
Practice Address - Country:US
Practice Address - Phone:831-479-9494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-07
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA520670101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health