Provider Demographics
NPI:1679724561
Name:BRICK, GAIL Y (ANP)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:Y
Last Name:BRICK
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2170 PEARL ST
Mailing Address - Street 2:
Mailing Address - City:BELVIDERE
Mailing Address - State:IL
Mailing Address - Zip Code:61008-6020
Mailing Address - Country:US
Mailing Address - Phone:815-547-5461
Mailing Address - Fax:815-544-9681
Practice Address - Street 1:2170 PEARL ST
Practice Address - Street 2:
Practice Address - City:BELVIDERE
Practice Address - State:IL
Practice Address - Zip Code:61008-6020
Practice Address - Country:US
Practice Address - Phone:815-547-5461
Practice Address - Fax:815-544-9681
Is Sole Proprietor?:No
Enumeration Date:2008-10-09
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209007292363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL617260001Medicare PIN