1215790209 NPI number — MRS. ALISON ANN GILLIS ACNPC-AG

Table of content: MRS. ALISON ANN GILLIS ACNPC-AG (NPI 1215790209)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215790209 NPI number — MRS. ALISON ANN GILLIS ACNPC-AG

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GILLIS
Provider First Name:
ALISON
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
ACNPC-AG
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BROWN
Provider Other First Name:
ALISON
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
AGNPC-AG, ARNP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1215790209
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/01/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
701 10TH ST SE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CEDAR RAPIDS
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52403-1292
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
319-861-7684
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
788 8TH AVE SE STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CEDAR RAPIDS
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52401-2106
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-221-8788
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/01/2024

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LA2100X , with the licence number:  H177846 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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