Healthcare Provider Details

I. General information

NPI: 1518666460
Provider Name (Legal Business Name): VICTORIA GEBERT RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2023
Last Update Date: 07/18/2024
Certification Date: 07/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 W HARRISON ST
CHICAGO IL
60612-3801
US

IV. Provider business mailing address

513 S DAMEN AVE APT 705
CHICAGO IL
60612-5592
US

V. Phone/Fax

Practice location:
  • Phone: 888-352-7874
  • Fax:
Mailing address:
  • Phone: 224-830-1505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041.560829
License Number StateIL
# 4
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number043.130652
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: