Provider Demographics
NPI:1407234255
Name:BECK, GINA (ANP)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:BECK
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:
Other - Last Name:MARRERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:901 MCCLINTOCK DR
Mailing Address - Street 2:STE 202
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-0871
Mailing Address - Country:US
Mailing Address - Phone:888-220-6432
Mailing Address - Fax:630-654-4253
Practice Address - Street 1:901 MCCLINTOCK DR
Practice Address - Street 2:STE 202
Practice Address - City:BURR RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60527-0871
Practice Address - Country:US
Practice Address - Phone:888-220-6432
Practice Address - Fax:630-654-4253
Is Sole Proprietor?:No
Enumeration Date:2015-05-13
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209012795363L00000X
IL041249726363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF400278725Medicare PIN
ILF400278728Medicare PIN
ILF400278729Medicare PIN
ILF400278727Medicare PIN