Provider Demographics
NPI:1740700988
Name:GILLILAND, LISA LEE ANN
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:LEE ANN
Last Name:GILLILAND
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:LISA GILLILAND
Mailing Address - Street 2:2001 W UTE PLACE
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74127-2250
Mailing Address - Country:US
Mailing Address - Phone:918-271-3818
Mailing Address - Fax:918-271-3818
Practice Address - Street 1:2001 W UTE PL
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74127
Practice Address - Country:US
Practice Address - Phone:918-271-3818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-20
Last Update Date:2017-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator