Provider Demographics
NPI:1578912408
Name:PROTHRO, GILLIAN LILO (DNP, FNP BC)
Entity Type:Individual
Prefix:DR
First Name:GILLIAN
Middle Name:LILO
Last Name:PROTHRO
Suffix:
Gender:F
Credentials:DNP, FNP BC
Other - Prefix:DR
Other - First Name:LILO
Other - Middle Name:
Other - Last Name:FINK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DNP, FNP BC
Mailing Address - Street 1:18601 N. HWY 1
Mailing Address - Street 2:SUITE 163
Mailing Address - City:FORT BRAGG
Mailing Address - State:CA
Mailing Address - Zip Code:95437
Mailing Address - Country:US
Mailing Address - Phone:239-404-8740
Mailing Address - Fax:
Practice Address - Street 1:1425 MONTGOMERY ST.
Practice Address - Street 2:
Practice Address - City:RED BLUFF
Practice Address - State:CA
Practice Address - Zip Code:96080
Practice Address - Country:US
Practice Address - Phone:530-528-8600
Practice Address - Fax:530-528-8612
Is Sole Proprietor?:No
Enumeration Date:2016-06-10
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9302994163W00000X
NY3290511163W00000X
CA95006182363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse