Provider Demographics
NPI:1710206107
Name:GILLILAND, COLLEEN (CRNP)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:GILLILAND
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:274 3RD ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BEAVER
Mailing Address - State:PA
Mailing Address - Zip Code:15009-2333
Mailing Address - Country:US
Mailing Address - Phone:724-774-2942
Mailing Address - Fax:724-770-7943
Practice Address - Street 1:274 3RD ST
Practice Address - Street 2:SUITE 100
Practice Address - City:BEAVER
Practice Address - State:PA
Practice Address - Zip Code:15009-2333
Practice Address - Country:US
Practice Address - Phone:724-774-2942
Practice Address - Fax:724-770-7943
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-25
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP010831363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner