Basic Information
| Provider Information | |||||||||
| NPI: | 1437202678 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GILLILAND | ||||||||
| FirstName: | MARLENE | ||||||||
| MiddleName: | MAY | ||||||||
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| Credential: | CMA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1424 S 25TH AVE | ||||||||
| Address2: | |||||||||
| City: | YAKIMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 989025100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5094573622 | ||||||||
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| Practice Location | |||||||||
| Address1: | 408 BUSTER ROAD | ||||||||
| Address2: | |||||||||
| City: | TOPPENISH | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98958 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5098652102 | ||||||||
| FaxNumber: | 5098651729 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/19/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 247200000X | HC00148288 | WA | Y | Technologists, Technicians & Other Technical Service Providers | Technician, Other |
No ID Information.