Provider Demographics
NPI:1689761017
Name:GALL, ELIZABETH M (APRN)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:M
Last Name:GALL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27555 DIEHL RD.
Mailing Address - Street 2:
Mailing Address - City:WARRENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60555
Mailing Address - Country:US
Mailing Address - Phone:630-646-3884
Mailing Address - Fax:630-646-3797
Practice Address - Street 1:100 SPALDING DR.
Practice Address - Street 2:SUTIE 406
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-8137
Practice Address - Country:US
Practice Address - Phone:630-961-9485
Practice Address - Fax:630-961-9578
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041353764363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL$$$$$$$$$ 1Medicaid
IDQ71899Medicare UPIN
ILK30797Medicare PIN