Provider Demographics
NPI:1932367950
Name:GILLAY, PATRICIA V (NP)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:V
Last Name:GILLAY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 W RUSSELL ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SALINE
Mailing Address - State:MI
Mailing Address - Zip Code:48176-1160
Mailing Address - Country:US
Mailing Address - Phone:734-944-0322
Mailing Address - Fax:
Practice Address - Street 1:420 W RUSSELL ST
Practice Address - Street 2:SUITE 210
Practice Address - City:SALINE
Practice Address - State:MI
Practice Address - Zip Code:48176-1160
Practice Address - Country:US
Practice Address - Phone:734-944-0322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-27
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI089030363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP16786Medicare UPIN
MI0812760Medicare PIN