Provider Demographics
NPI:1750354882
Name:GILLIS, KATHLEEN JAN (RN MSN FNP)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:JAN
Last Name:GILLIS
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Gender:F
Credentials:RN MSN FNP
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Mailing Address - Street 1:3100 TELEGRAPH AVE
Mailing Address - Street 2:SUITE 2102
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-3210
Mailing Address - Country:US
Mailing Address - Phone:510-286-8160
Mailing Address - Fax:510-286-8158
Practice Address - Street 1:3100 TELEGRAPH AVE
Practice Address - Street 2:SUITE 2102
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3210
Practice Address - Country:US
Practice Address - Phone:510-286-8160
Practice Address - Fax:510-286-8158
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2021-04-23
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Provider Licenses
StateLicense IDTaxonomies
CARN289570163W00000X
CA7266363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0028630Medicaid
P57006Medicare UPIN
CAZZZ16371ZMedicare ID - Type Unspecified