Healthcare Provider Details

I. General information

NPI: 1881558179
Provider Name (Legal Business Name): JEANETTE GURRISTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JEANETTE GARCIA

II. Dates (important events)

Enumeration Date: 12/11/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 N COUNTY FARM RD
WHEATON IL
60187-3977
US

IV. Provider business mailing address

111 N COUNTY FARM RD
WHEATON IL
60187-3977
US

V. Phone/Fax

Practice location:
  • Phone: 630-627-1700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number041.561039
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: