Provider Demographics
NPI:1750887295
Name:ATAM, GILLIAN A (FNP)
Entity type:Individual
Prefix:
First Name:GILLIAN
Middle Name:A
Last Name:ATAM
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:GILLIAN
Other - Middle Name:AKWEN
Other - Last Name:ATAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP
Mailing Address - Street 1:4055 VALLEY VIEW LN STE 400
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75244-5071
Mailing Address - Country:US
Mailing Address - Phone:972-715-3800
Mailing Address - Fax:
Practice Address - Street 1:4055 VALLEY VIEW LN STE 400D
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75244-5074
Practice Address - Country:US
Practice Address - Phone:972-715-3800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-03
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX830982163W00000X
TX144581363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX144581OtherAP