Provider Demographics
NPI:1710066766
Name:GILFILLAN, KATHLEEN BOYER (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:BOYER
Last Name:GILFILLAN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 OAK BROOK CT
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95602-7631
Mailing Address - Country:US
Mailing Address - Phone:530-878-6860
Mailing Address - Fax:530-878-6861
Practice Address - Street 1:6283 CLARK RD STE 10
Practice Address - Street 2:
Practice Address - City:PARADISE
Practice Address - State:CA
Practice Address - Zip Code:95969-4100
Practice Address - Country:US
Practice Address - Phone:530-877-2020
Practice Address - Fax:530-877-4641
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA258082367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA3 RN2580820Medicaid
CAZZZ19049ZMedicare ID - Type Unspecified
CAP16727Medicare UPIN