Provider Demographics
NPI:1366722290
Name:GILLIAM, KATHERINE MARIE (LPN)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:MARIE
Last Name:GILLIAM
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:MARIE
Other - Last Name:POWER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:352 HIGHBANKS VALLEY CT
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-9253
Mailing Address - Country:US
Mailing Address - Phone:740-405-7220
Mailing Address - Fax:
Practice Address - Street 1:352 HIGHBANKS VALLEY CT
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-9253
Practice Address - Country:US
Practice Address - Phone:740-405-7220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-23
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH140297164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse