Provider Demographics
NPI:1568128890
Name:GILMAN, MLEANEN MARCIA (NP-C)
Entity Type:Individual
Prefix:MS
First Name:MLEANEN
Middle Name:MARCIA
Last Name:GILMAN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 EDGAR RD
Mailing Address - Street 2:
Mailing Address - City:TOWNSEND
Mailing Address - State:DE
Mailing Address - Zip Code:19734-2417
Mailing Address - Country:US
Mailing Address - Phone:302-464-9757
Mailing Address - Fax:
Practice Address - Street 1:677 E PULASKI HWY
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-6037
Practice Address - Country:US
Practice Address - Phone:302-595-3670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-10
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASPO24714363LF0000X
MDAC004580363LF0000X
DELG-0011814363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily