Provider Demographics
NPI:1205490471
Name:GILLIAM, JOYCELYN
Entity type:Individual
Prefix:
First Name:JOYCELYN
Middle Name:
Last Name:GILLIAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87-160 MAIPALAOA RD # F
Mailing Address - Street 2:
Mailing Address - City:WAIANAE
Mailing Address - State:HI
Mailing Address - Zip Code:96792-3214
Mailing Address - Country:US
Mailing Address - Phone:910-813-7293
Mailing Address - Fax:
Practice Address - Street 1:87-160 MAIPALAOA RD # F
Practice Address - Street 2:
Practice Address - City:WAIANAE
Practice Address - State:HI
Practice Address - Zip Code:96792-3214
Practice Address - Country:US
Practice Address - Phone:910-813-7293
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-23
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI89761163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool