Provider Demographics
NPI:1437441318
Name:GEWARGIS, MARY (ANP-BC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:GEWARGIS
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:GEWARGIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ANP-C, FNP-C
Mailing Address - Street 1:1441 BRANDING AVE
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-1160
Mailing Address - Country:US
Mailing Address - Phone:630-829-1084
Mailing Address - Fax:
Practice Address - Street 1:1441 BRANDING AVE
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-1160
Practice Address - Country:US
Practice Address - Phone:630-829-1084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-10
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209008798363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1437441318OtherNPI