Provider Demographics
NPI:1518088640
Name:GILBERT, LILLA WD (CNP)
Entity Type:Individual
Prefix:
First Name:LILLA
Middle Name:WD
Last Name:GILBERT
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 1:1130 TOWER BLVD
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44052-5235
Mailing Address - Country:US
Mailing Address - Phone:440-989-4875
Mailing Address - Fax:
Practice Address - Street 1:1130 TOWER BLVD
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44052-5235
Practice Address - Country:US
Practice Address - Phone:440-989-4875
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP-05114363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2182249Medicaid
OHS92087Medicare UPIN
OHNP04383Medicare ID - Type Unspecified