Provider Demographics
NPI:1033322755
Name:GILLEN, PAULA (NAP-PCA)
Entity type:Individual
Prefix:MRS
First Name:PAULA
Middle Name:
Last Name:GILLEN
Suffix:
Gender:F
Credentials:NAP-PCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24201 PURITAN RD
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44123-2253
Mailing Address - Country:US
Mailing Address - Phone:440-728-1224
Mailing Address - Fax:
Practice Address - Street 1:24201 PURITAN RD
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44123-2253
Practice Address - Country:US
Practice Address - Phone:440-728-1224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2571720Medicaid