Provider Demographics
NPI:1851872279
Name:CLIFFORD, GILLIAN MARGARET (NP)
Entity Type:Individual
Prefix:
First Name:GILLIAN
Middle Name:MARGARET
Last Name:CLIFFORD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:27140 CLAIRVIEW DR
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48127-1679
Mailing Address - Country:US
Mailing Address - Phone:313-231-1887
Mailing Address - Fax:
Practice Address - Street 1:WESTERN WAYNE FAMILY HEALTH CENTERS
Practice Address - Street 2:2700 HAMLIN BLVD.
Practice Address - City:INKSTER
Practice Address - State:MI
Practice Address - Zip Code:48141
Practice Address - Country:US
Practice Address - Phone:313-561-5100
Practice Address - Fax:313-565-0309
Is Sole Proprietor?:No
Enumeration Date:2018-08-23
Last Update Date:2018-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704235517363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily