Provider Demographics
NPI:1922144286
Name:GILL, LISA M (ANP)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:M
Last Name:GILL
Suffix:
Gender:F
Credentials:ANP
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Mailing Address - Street 1:PO BOX 60352
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63160-0352
Mailing Address - Country:US
Mailing Address - Phone:314-362-1700
Mailing Address - Fax:314-362-9878
Practice Address - Street 1:1 BARNES JEWISH HOSPITAL PLZ
Practice Address - Street 2:DIV IM HOSPITALIST
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1003
Practice Address - Country:US
Practice Address - Phone:314-362-1700
Practice Address - Fax:314-362-9878
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2024-04-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO126677363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO424366409Medicaid
MO1922144286Medicaid