Provider Demographics
NPI:1215530332
Name:GILLIAM, NAOMI LOIS
Entity type:Individual
Prefix:
First Name:NAOMI
Middle Name:LOIS
Last Name:GILLIAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 ALDRIDGE HOLW
Mailing Address - Street 2:
Mailing Address - City:GREENUP
Mailing Address - State:KY
Mailing Address - Zip Code:41144-7364
Mailing Address - Country:US
Mailing Address - Phone:606-465-6608
Mailing Address - Fax:
Practice Address - Street 1:333 ALDRIDGE HOLW
Practice Address - Street 2:
Practice Address - City:GREENUP
Practice Address - State:KY
Practice Address - Zip Code:41144-7364
Practice Address - Country:US
Practice Address - Phone:606-465-6608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH9800648374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide