Provider Demographics
NPI:1750805164
Name:GILLILAND, PAIGE
Entity type:Individual
Prefix:
First Name:PAIGE
Middle Name:
Last Name:GILLILAND
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 1:2001 W UTE PL
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74127-2250
Mailing Address - Country:US
Mailing Address - Phone:702-217-5430
Mailing Address - Fax:
Practice Address - Street 1:2001 W UTE PL
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74127-2250
Practice Address - Country:US
Practice Address - Phone:702-217-5430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator