Provider Demographics
NPI:1952758724
Name:GILMORE, BILLY JANE MAY (LPN)
Entity Type:Individual
Prefix:
First Name:BILLY JANE
Middle Name:MAY
Last Name:GILMORE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38776 PLACE RD
Mailing Address - Street 2:
Mailing Address - City:FALL CREEK
Mailing Address - State:OR
Mailing Address - Zip Code:97438-9711
Mailing Address - Country:US
Mailing Address - Phone:541-216-3893
Mailing Address - Fax:
Practice Address - Street 1:2360 CHAMBERS ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405-1861
Practice Address - Country:US
Practice Address - Phone:541-687-1310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-20
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201602910164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse