Provider Demographics
NPI:1053545681
Name:GILLIS, LAUREN NICOLE (ANP-BC)
Entity type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:NICOLE
Last Name:GILLIS
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:N
Other - Last Name:GILLIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:600 GRESHAM DR STE 8630
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23507-1904
Mailing Address - Country:US
Mailing Address - Phone:757-388-6005
Mailing Address - Fax:757-388-6006
Practice Address - Street 1:600 GRESHAM DR STE 8630
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1904
Practice Address - Country:US
Practice Address - Phone:757-388-6005
Practice Address - Fax:757-388-6006
Is Sole Proprietor?:No
Enumeration Date:2009-05-11
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024168262363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health