Provider Demographics
NPI:1609182112
Name:GILLEY, JANUARY NICOLE (CLC)
Entity Type:Individual
Prefix:
First Name:JANUARY
Middle Name:NICOLE
Last Name:GILLEY
Suffix:
Gender:F
Credentials:CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8600 S ACADEMY WAY
Mailing Address - Street 2:
Mailing Address - City:LADOGA
Mailing Address - State:IN
Mailing Address - Zip Code:47954-8112
Mailing Address - Country:US
Mailing Address - Phone:765-918-6893
Mailing Address - Fax:
Practice Address - Street 1:8600 S ACADEMY WAY
Practice Address - Street 2:
Practice Address - City:LADOGA
Practice Address - State:IN
Practice Address - Zip Code:47954-8112
Practice Address - Country:US
Practice Address - Phone:765-918-6893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-20
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula