Provider Demographics
NPI:1700844529
Name:GILLILAND, GERALD JAMES (ANP)
Entity Type:Individual
Prefix:MR
First Name:GERALD
Middle Name:JAMES
Last Name:GILLILAND
Suffix:
Gender:M
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1308 KENILWORTH AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:WI
Mailing Address - Zip Code:53403-3642
Mailing Address - Country:US
Mailing Address - Phone:608-513-0383
Mailing Address - Fax:
Practice Address - Street 1:2919 STOUT RD
Practice Address - Street 2:
Practice Address - City:MENOMONIE
Practice Address - State:WI
Practice Address - Zip Code:54751-2313
Practice Address - Country:US
Practice Address - Phone:715-309-4451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-02
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP8055363LA2200X
WI102440-030363LA2200X
WI238333363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health