Healthcare Provider Details

I. General information

NPI: 1295827319
Provider Name (Legal Business Name): GABRIELLE M MUDRAK RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 S GREENLEAF ST SUITE A
GURNEE IL
60031-3377
US

IV. Provider business mailing address

33640 N ALMOND RD
GRAYSLAKE IL
60030-1802
US

V. Phone/Fax

Practice location:
  • Phone: 847-244-0222
  • Fax: 847-244-7122
Mailing address:
  • Phone: 847-367-9484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: