Provider Demographics
NPI:1972860344
Name:GILLIGAN, JAMIE EDENS (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:EDENS
Last Name:GILLIGAN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 GATEWAY CORPORATE BLVD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-9611
Mailing Address - Country:US
Mailing Address - Phone:828-230-6487
Mailing Address - Fax:
Practice Address - Street 1:120 GATEWAY CORPORATE BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-9611
Practice Address - Country:US
Practice Address - Phone:828-230-6487
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-23
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC236151163W00000X
SC17885367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse