Theodora Joan Gilliam, RN is a
Registered Nurse based in Elkhart Lake, Wisconsin. Theodora Joan Gilliam is licensed to practice in Wisconsin (license number 60785-30) and her current practice location is
198 S. Est St., Elkhart Lake, Wisconsin. She can be reached at her office (for appointments etc.) via phone at
(920) 286-0284.
NPI number for Theodora Joan Gilliam is 1376991281 and her current mailing address is Po Box 73, Elkhart Lake, Wisconsin. She
does not participate in medicare program and thus does not accept medicare assignments. Her NPI Number is 1376991281.
Provider's Profile
| Full Name | Theodora Joan Gilliam |
|---|
| Gender | Female |
|---|
| Speciality | Registered Nurse |
|---|
| Location | 198 S. Est St., Elkhart Lake, Wisconsin |
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| Accepts Medicare Assignments | Does not participate in Medicare Program. She may not accept medicare assignment. |
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NPI Data:
- NPI Number: 1376991281
- Provider Enumeration Date: 06/01/2016
- Last Update Date: 06/01/2016
Medical Identifiers
Medical identifiers for Theodora Joan Gilliam such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1376991281 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 163W00000X | Registered Nurse | 60785-30 (Wisconsin) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Theodora Joan Gilliam is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Theodora Joan Gilliam, RN
Po Box 73,
Elkhart Lake, WI 53020-0073
Ph: (920) 286-0284 | Theodora Joan Gilliam, RN
198 S. Est St.,
Elkhart Lake, WI 53020-0073
Ph: (920) 286-0284 |
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