Provider Demographics
NPI:1043901978
Name:GILLING, BETHANY M (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:BETHANY
Middle Name:M
Last Name:GILLING
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2025 LOCHNAYNE LN
Mailing Address - Street 2:
Mailing Address - City:DAVISON
Mailing Address - State:MI
Mailing Address - Zip Code:48423-8375
Mailing Address - Country:US
Mailing Address - Phone:810-358-2196
Mailing Address - Fax:
Practice Address - Street 1:1537 E HILL RD STE 400
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-5190
Practice Address - Country:US
Practice Address - Phone:810-333-7309
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-19
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704276283363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily