Provider Demographics
NPI:1013024827
Name:GILBREATH, JANET LEA (NP)
Entity Type:Individual
Prefix:DR
First Name:JANET
Middle Name:LEA
Last Name:GILBREATH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2360 W FOXGLOVE DR
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83686-4955
Mailing Address - Country:US
Mailing Address - Phone:630-854-4115
Mailing Address - Fax:
Practice Address - Street 1:23W134 SHERBROOKE LN
Practice Address - Street 2:
Practice Address - City:GLEN ELLYN
Practice Address - State:IL
Practice Address - Zip Code:60137-6921
Practice Address - Country:US
Practice Address - Phone:630-854-4115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209004763363LF0000X
IL103024827363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1013024827OtherNPI NUMBER
IL209004763OtherLICENSE