Provider Demographics
NPI:1366466989
Name:DELUCA, GAIL L (RN,APN)
Entity Type:Individual
Prefix:MRS
First Name:GAIL
Middle Name:L
Last Name:DELUCA
Suffix:
Gender:F
Credentials:RN,APN
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:29373 NETWORK PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-2207
Mailing Address - Country:US
Mailing Address - Phone:847-390-5900
Mailing Address - Fax:
Practice Address - Street 1:1710 N RANDALL RD STE 200
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-9402
Practice Address - Country:US
Practice Address - Phone:847-214-5740
Practice Address - Fax:847-214-5757
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-001626363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP02932Medicare UPIN