Provider Demographics
NPI:1740683986
Name:GILFILLIAN, PAULA PAMELLA (LPN)
Entity type:Individual
Prefix:MISS
First Name:PAULA
Middle Name:PAMELLA
Last Name:GILFILLIAN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:814 A TILDEN ST.
Mailing Address - Street 2:APT 4D
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467
Mailing Address - Country:US
Mailing Address - Phone:347-595-4572
Mailing Address - Fax:
Practice Address - Street 1:814 TILDEN ST # A
Practice Address - Street 2:APT 4D
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-6027
Practice Address - Country:US
Practice Address - Phone:347-595-4572
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-02
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY318410-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse