Provider Demographics
NPI:1457168833
Name:GILLIAM, RENEE TAYLOR (CNM)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:TAYLOR
Last Name:GILLIAM
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:RENEE
Other - Middle Name:MONIQUE
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:301 WESSEX RD
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24501-4078
Mailing Address - Country:US
Mailing Address - Phone:434-825-6835
Mailing Address - Fax:
Practice Address - Street 1:39 BEAM LN
Practice Address - Street 2:
Practice Address - City:FISHERSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22939-2348
Practice Address - Country:US
Practice Address - Phone:540-213-7750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-18
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife