Healthcare Provider Details

I. General information

NPI: 1144110289
Provider Name (Legal Business Name): VINCENT GEBALA APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2025
Last Update Date: 07/09/2025
Certification Date: 07/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 75TH ST
WILLOWBROOK IL
60527-2325
US

IV. Provider business mailing address

11201 SHELLEY ST
WESTCHESTER IL
60154-4165
US

V. Phone/Fax

Practice location:
  • Phone: 630-581-5372
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209032208
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: