Provider Demographics
NPI:1689052698
Name:MCGILLIS, VICTORIA (FNP-BC)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:MCGILLIS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 E M 55 STE B
Mailing Address - Street 2:
Mailing Address - City:TAWAS CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48763-8211
Mailing Address - Country:US
Mailing Address - Phone:989-362-6426
Mailing Address - Fax:989-362-6527
Practice Address - Street 1:325 E M 55 STE B
Practice Address - Street 2:
Practice Address - City:TAWAS CITY
Practice Address - State:MI
Practice Address - Zip Code:48763
Practice Address - Country:US
Practice Address - Phone:989-362-6426
Practice Address - Fax:989-362-6527
Is Sole Proprietor?:No
Enumeration Date:2015-05-11
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704244691363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4704244691OtherLICENSE