Provider Demographics
NPI:1972810281
Name:GILSON, LINDA DIANE (ANP)
Entity type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:DIANE
Last Name:GILSON
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3857 FAIRVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:KETCHIKAN
Mailing Address - State:AK
Mailing Address - Zip Code:99901-5335
Mailing Address - Country:US
Mailing Address - Phone:907-225-2343
Mailing Address - Fax:
Practice Address - Street 1:212 CARLANNA LAKE RD
Practice Address - Street 2:100
Practice Address - City:KETCHIKAN
Practice Address - State:AK
Practice Address - Zip Code:99901-5658
Practice Address - Country:US
Practice Address - Phone:907-228-8140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-08
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK0043363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health