Provider Demographics
NPI:1356589311
Name:GILLILAND, MARY S (CNS)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:S
Last Name:GILLILAND
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:S
Other - Last Name:ADAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNS
Mailing Address - Street 1:1919 S WHEELING STE 500
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104
Mailing Address - Country:US
Mailing Address - Phone:918-748-7650
Mailing Address - Fax:
Practice Address - Street 1:1301 W 6TH AVE STE 207
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-4381
Practice Address - Country:US
Practice Address - Phone:405-533-3010
Practice Address - Fax:405-533-3013
Is Sole Proprietor?:No
Enumeration Date:2009-01-29
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0030806364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKR0030806OtherSTATE LIC.