Provider Demographics
NPI:1659830057
Name:DEAN, GINGER (APRN)
Entity Type:Individual
Prefix:MRS
First Name:GINGER
Middle Name:
Last Name:DEAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MISS
Other - First Name:GINGER
Other - Middle Name:
Other - Last Name:STEVENS DEAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 2944
Mailing Address - Street 2:
Mailing Address - City:COUNTRY CLUB HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60478-8944
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2843 CHICAGO RD
Practice Address - Street 2:
Practice Address - City:SOUTH CHICAGO HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60411-4736
Practice Address - Country:US
Practice Address - Phone:708-441-2158
Practice Address - Fax:708-575-1669
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-15
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209019007363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health