Provider Demographics
NPI:1245278464
Name:GILLIAM, NANCY J (APN BC)
Entity type:Individual
Prefix:MS
First Name:NANCY
Middle Name:J
Last Name:GILLIAM
Suffix:
Gender:F
Credentials:APN BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:755 MEMORIAL PKWY STE 106
Mailing Address - Street 2:
Mailing Address - City:PHILLIPSBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08865-2774
Mailing Address - Country:US
Mailing Address - Phone:908-847-0514
Mailing Address - Fax:866-747-3167
Practice Address - Street 1:755 MEMORIAL PKWY STE 106
Practice Address - Street 2:
Practice Address - City:PHILLIPSBURG
Practice Address - State:NJ
Practice Address - Zip Code:08865
Practice Address - Country:US
Practice Address - Phone:908-847-0514
Practice Address - Fax:866-747-3167
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2018-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00077700363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0058432Medicaid
NJ223733353OtherHORIZON
NJ2318736OtherAETNA
Q39033Medicare UPIN
NJ223733353OtherHORIZON