Provider Demographics
NPI:1730625567
Name:GILLESPIE, ROBERT B (LPN)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:B
Last Name:GILLESPIE
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:347 MANN AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRBORN
Mailing Address - State:OH
Mailing Address - Zip Code:45324-5152
Mailing Address - Country:US
Mailing Address - Phone:937-234-3766
Mailing Address - Fax:
Practice Address - Street 1:2601 PARKLAWN DR
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45440-1251
Practice Address - Country:US
Practice Address - Phone:937-499-1780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-18
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHP.N.151275164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse