Provider Demographics
NPI:1598011702
Name:GILLILAND, GREG W (RN)
Entity Type:Individual
Prefix:
First Name:GREG
Middle Name:W
Last Name:GILLILAND
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51621 N DEMOSS RD
Mailing Address - Street 2:
Mailing Address - City:BENTON CITY
Mailing Address - State:WA
Mailing Address - Zip Code:99320-5177
Mailing Address - Country:US
Mailing Address - Phone:509-588-2616
Mailing Address - Fax:
Practice Address - Street 1:51621 N DEMOSS RD
Practice Address - Street 2:
Practice Address - City:BENTON CITY
Practice Address - State:WA
Practice Address - Zip Code:99320-5177
Practice Address - Country:US
Practice Address - Phone:509-588-2616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-25
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60092637163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management