Provider Demographics
NPI:1104171180
Name:GILLESPIE, EILEEN FRANCES (NP)
Entity type:Individual
Prefix:
First Name:EILEEN
Middle Name:FRANCES
Last Name:GILLESPIE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10201 66TH RD
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-2029
Mailing Address - Country:US
Mailing Address - Phone:718-830-1996
Mailing Address - Fax:718-830-1676
Practice Address - Street 1:10201 66TH RD
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-2029
Practice Address - Country:US
Practice Address - Phone:718-830-1996
Practice Address - Fax:718-830-1676
Is Sole Proprietor?:No
Enumeration Date:2012-07-17
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF336973-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily