Provider Demographics
NPI:1457931750
Name:GILLELAND, LISA A
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:A
Last Name:GILLELAND
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 1:255 SPRING CREST DR
Mailing Address - Street 2:
Mailing Address - City:LAKESIDE MARBLEHEAD
Mailing Address - State:OH
Mailing Address - Zip Code:43440-9696
Mailing Address - Country:US
Mailing Address - Phone:141-963-5668
Mailing Address - Fax:
Practice Address - Street 1:2540 BILLINGSLEY RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43235-1990
Practice Address - Country:US
Practice Address - Phone:614-602-6476
Practice Address - Fax:614-953-2802
Is Sole Proprietor?:No
Enumeration Date:2021-04-11
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No376J00000XNursing Service Related ProvidersHomemaker