Provider Demographics
NPI:1831547504
Name:GILLIS, HEATHER (ARNP)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:GILLIS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9621 RIDGETOP BLVD NW
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-8502
Mailing Address - Country:US
Mailing Address - Phone:360-782-3600
Mailing Address - Fax:
Practice Address - Street 1:9621 RIDGETOP BLVD NW
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-8502
Practice Address - Country:US
Practice Address - Phone:360-782-3300
Practice Address - Fax:360-782-3450
Is Sole Proprietor?:No
Enumeration Date:2016-06-02
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60667211363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily