Basic Information
Provider Information
NPI: 1376600544
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GILPIN
FirstName: PATRICIA
MiddleName:  
NamePrefix: PROF.
NameSuffix:  
Credential: APRN,BC.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 122 SILVER LAKE RD
Address2:  
City: MIDDLETOWN
State: DE
PostalCode: 197091225
CountryCode: US
TelephoneNumber: 3023785775
FaxNumber: 3023785760
Practice Location
Address1: 122 SILVER LAKE RD
Address2:  
City: MIDDLETOWN
State: DE
PostalCode: 197091225
CountryCode: US
TelephoneNumber: 3023785775
FaxNumber: 3023785760
Other Information
ProviderEnumerationDate: 01/03/2007
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000XLG-0000325DEY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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