Provider Demographics
NPI:1295827319
Name:MUDRAK, GABRIELLE M (RN)
Entity Type:Individual
Prefix:MRS
First Name:GABRIELLE
Middle Name:M
Last Name:MUDRAK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33640 N ALMOND RD
Mailing Address - Street 2:
Mailing Address - City:GRAYSLAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60030-1802
Mailing Address - Country:US
Mailing Address - Phone:847-367-9484
Mailing Address - Fax:
Practice Address - Street 1:3 S GREENLEAF ST
Practice Address - Street 2:SUITE A
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-3377
Practice Address - Country:US
Practice Address - Phone:847-244-0222
Practice Address - Fax:847-244-7122
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL163WW0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory