Provider Demographics
NPI:1306516265
Name:GILLES, NICOLE KRISTINE (FNP)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:KRISTINE
Last Name:GILLES
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2522 GOLF RD STE 2
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-6033
Mailing Address - Country:US
Mailing Address - Phone:715-833-0660
Mailing Address - Fax:
Practice Address - Street 1:309 3RD AVE W
Practice Address - Street 2:
Practice Address - City:DURAND
Practice Address - State:WI
Practice Address - Zip Code:54736-1165
Practice Address - Country:US
Practice Address - Phone:715-368-2340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-14
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN11145363LF0000X, 363L00000X
WI11332-33363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily