Provider Demographics
NPI:1932256013
Name:GILLEY, LORRAINE TAYLOR (FNP-C)
Entity Type:Individual
Prefix:
First Name:LORRAINE
Middle Name:TAYLOR
Last Name:GILLEY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18285 TABLE ROCK RD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80908-1520
Mailing Address - Country:US
Mailing Address - Phone:719-495-1018
Mailing Address - Fax:
Practice Address - Street 1:3190 E LAS VEGAS ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-8002
Practice Address - Country:US
Practice Address - Phone:719-390-2735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO83780363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily