Provider Demographics
NPI:1396042750
Name:GILL, DEBRA SUSAN (FNP)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:SUSAN
Last Name:GILL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:518 UVEDALE RD
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60546-1611
Mailing Address - Country:US
Mailing Address - Phone:708-442-1813
Mailing Address - Fax:
Practice Address - Street 1:4 E OGDEN AVE
Practice Address - Street 2:
Practice Address - City:WESTMONT
Practice Address - State:IL
Practice Address - Zip Code:60559-3506
Practice Address - Country:US
Practice Address - Phone:630-323-9885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-22
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.008578363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily