Provider Demographics
NPI:1982976064
Name:GEMBICA-BUE, BARB J (RN)
Entity Type:Individual
Prefix:
First Name:BARB
Middle Name:J
Last Name:GEMBICA-BUE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:BARB
Other - Middle Name:J
Other - Last Name:BUE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:1845 GLADSTONE AVE
Mailing Address - Street 2:SECOND FL
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123
Mailing Address - Country:US
Mailing Address - Phone:847-695-0484
Mailing Address - Fax:847-760-0856
Practice Address - Street 1:1845 GLADSTONE AVE
Practice Address - Street 2:SECOND FL
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123
Practice Address - Country:US
Practice Address - Phone:847-695-0484
Practice Address - Fax:847-760-0856
Is Sole Proprietor?:No
Enumeration Date:2012-02-03
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.204220163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILREGISTERED NURSEMedicaid