Provider Demographics
NPI:1770338253
Name:GILLILAND, JUDITH T (RN)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:T
Last Name:GILLILAND
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45-249 KENELA ST
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-2204
Mailing Address - Country:US
Mailing Address - Phone:808-230-1859
Mailing Address - Fax:
Practice Address - Street 1:459 PATTERSON RD BLDG 110
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96819-1522
Practice Address - Country:US
Practice Address - Phone:808-433-0259
Practice Address - Fax:808-433-0307
Is Sole Proprietor?:No
Enumeration Date:2024-04-18
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIRN48570163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse