Provider Demographics
NPI:1871817205
Name:GULLISON, OLIVIA GAY (MED)
Entity Type:Individual
Prefix:MS
First Name:OLIVIA
Middle Name:GAY
Last Name:GULLISON
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 JOHNNYCAKE LN
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:RI
Mailing Address - Zip Code:02871-4109
Mailing Address - Country:US
Mailing Address - Phone:401-474-8030
Mailing Address - Fax:
Practice Address - Street 1:1 JOHNNYCAKE LN
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:RI
Practice Address - Zip Code:02871-4109
Practice Address - Country:US
Practice Address - Phone:401-474-8030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-14
Last Update Date:2010-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program