Provider Demographics
NPI:1760810535
Name:GENTILE, ELISE MADECK (MS, APN, CPNP)
Entity Type:Individual
Prefix:
First Name:ELISE
Middle Name:MADECK
Last Name:GENTILE
Suffix:
Gender:F
Credentials:MS, APN, CPNP
Other - Prefix:
Other - First Name:ELISE
Other - Middle Name:MARIE
Other - Last Name:MADECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, APN, CPNP
Mailing Address - Street 1:1011 BERNETTE CT
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-4837
Mailing Address - Country:US
Mailing Address - Phone:847-651-8055
Mailing Address - Fax:
Practice Address - Street 1:4440 W 95TH ST
Practice Address - Street 2:SUITE 2177H
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2600
Practice Address - Country:US
Practice Address - Phone:708-684-3595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-14
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.009674363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics