Basic Information
| Provider Information | |||||||||
| NPI: | 1750945986 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GILLIHAN | ||||||||
| FirstName: | KATIE | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 727 | ||||||||
| Address2: | |||||||||
| City: | WATERVILLE | ||||||||
| State: | ME | ||||||||
| PostalCode: | 049030727 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2076609926 | ||||||||
| FaxNumber: | 2076609901 | ||||||||
| Practice Location | |||||||||
| Address1: | 4 CLEMENT WAY | ||||||||
| Address2: | |||||||||
| City: | BELGRADE | ||||||||
| State: | ME | ||||||||
| PostalCode: | 049174370 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2074953323 | ||||||||
| FaxNumber: | 2074953353 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/23/2019 | ||||||||
| LastUpdateDate: | 01/24/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN67508 | ME | N | Nursing Service Providers | Registered Nurse | 363LF0000X | CNP211196 | ME | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.