Provider Demographics
NPI:1851743561
Name:GILSON, MIA (PA-C)
Entity Type:Individual
Prefix:
First Name:MIA
Middle Name:
Last Name:GILSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MIA
Other - Middle Name:
Other - Last Name:MALIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:979 E 3RD ST STE C735
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37403-3310
Mailing Address - Country:US
Mailing Address - Phone:423-778-9101
Mailing Address - Fax:423-778-9190
Practice Address - Street 1:200 NE MOTHER JOSEPH PL STE 330
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98664-3288
Practice Address - Country:US
Practice Address - Phone:360-514-2990
Practice Address - Fax:360-514-3508
Is Sole Proprietor?:No
Enumeration Date:2016-07-06
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3392363A00000X
WAPA61129329363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant