Healthcare Provider Details

I. General information

NPI: 1396672259
Provider Name (Legal Business Name): BRIZZA CELESTE GILLETTE DNP- PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 S VIRGINIA ST
CRYSTAL LAKE IL
60014-7226
US

IV. Provider business mailing address

198 AUTUMNWOOD LN
DAVIS JUNCTION IL
61020-9425
US

V. Phone/Fax

Practice location:
  • Phone: 815-520-1369
  • Fax:
Mailing address:
  • Phone: 815-520-1369
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number209.035526
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: