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General NPI Number Information
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NPI Number | 1306797717
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Entity Type | Individual
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Provider Name | CHRISTOPHER MIRACLE GBUNNOR
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Gender | Male
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Dates
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Enumeration Date | 02/04/2026
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Last Update Date | 02/04/2026
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Provider Practice Location Address
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Address Line | 7300 W COLLEGE DR STE 102
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City | PALOS HEIGHTS
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State | IL
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Zip | 60463-1181
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Country | US
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Telephone | 708-296-0230
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Fax |
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Provider Business Mailing Address
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Address Line | 6603 S RHODES AVE APT 1N
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City | CHICAGO
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State | IL
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Zip | 60637-4144
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Country | US
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Telephone | 872-808-9152
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 209034417
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License Number State | IL
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