Provider Demographics
NPI:1598578544
Name:GILLEN, KATELYN MICHELLE
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:MICHELLE
Last Name:GILLEN
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 1:2746 S 41ST ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68105-3302
Mailing Address - Country:US
Mailing Address - Phone:402-810-2204
Mailing Address - Fax:
Practice Address - Street 1:14504 S 23RD ST
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68123-4710
Practice Address - Country:US
Practice Address - Phone:402-350-1679
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-31
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider