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General NPI Number Information
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NPI Number | 1114472610
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Entity Type | Individual
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Provider Name | TARAH NOEL GIBBS NP
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Gender | Female
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Dates
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Enumeration Date | 08/25/2016
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Last Update Date | 04/12/2023
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Provider Practice Location Address
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Address Line | 2655 WARRENVILLE RD
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City | DOWNERS GROVE
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State | IL
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Zip | 60515-5555
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Country | US
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Telephone | 866-949-0108
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Fax |
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Provider Business Mailing Address
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Address Line | 1 WESTBROOK CORPORATE CTR STE 300
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City | WESTCHESTER
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State | IL
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Zip | 60154-5709
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Country | US
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Telephone | 866-949-0108
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 209014725
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 277000407
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License Number State | IL
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