Provider Demographics
NPI:1548772809
Name:MAPLES, GILLIAN D (FNP)
Entity type:Individual
Prefix:
First Name:GILLIAN
Middle Name:D
Last Name:MAPLES
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:GILLIAN
Other - Middle Name:D
Other - Last Name:MOON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8382 N WAYNE DR STE 204
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-6028
Mailing Address - Country:US
Mailing Address - Phone:208-635-5265
Mailing Address - Fax:208-635-5218
Practice Address - Street 1:8382 N WAYNE DR STE 204
Practice Address - Street 2:
Practice Address - City:HAYDEN
Practice Address - State:ID
Practice Address - Zip Code:83835-6028
Practice Address - Country:US
Practice Address - Phone:208-635-5265
Practice Address - Fax:208-635-5218
Is Sole Proprietor?:No
Enumeration Date:2017-10-26
Last Update Date:2025-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANPF95007537363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner