Provider Demographics
NPI:1043102635
Name:PFAFF, GILLIAN QUINN (NP)
Entity type:Individual
Prefix:
First Name:GILLIAN
Middle Name:QUINN
Last Name:PFAFF
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 HARRISON AVE APT 1027
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-3089
Mailing Address - Country:US
Mailing Address - Phone:248-312-9091
Mailing Address - Fax:
Practice Address - Street 1:345 HARRISON AVE APT 1027
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-3089
Practice Address - Country:US
Practice Address - Phone:248-312-9091
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-17
Last Update Date:2025-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2372706363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily