Provider Demographics
NPI:1093022360
Name:GEBHART, ANDREA (RN,CDE)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:
Last Name:GEBHART
Suffix:
Gender:F
Credentials:RN,CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3722 S. HARLEM AVE.
Mailing Address - Street 2:SUITE 202
Mailing Address - City:RIVERSIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60546
Mailing Address - Country:US
Mailing Address - Phone:708-783-6980
Mailing Address - Fax:708-783-6979
Practice Address - Street 1:3722 S. HARLEM AVE.
Practice Address - Street 2:SUITE 202
Practice Address - City:RIVERSIDE
Practice Address - State:IL
Practice Address - Zip Code:60546
Practice Address - Country:US
Practice Address - Phone:708-783-6980
Practice Address - Fax:708-783-6979
Is Sole Proprietor?:No
Enumeration Date:2010-09-08
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041-155749163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator