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General NPI Number Information
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NPI Number | 1447993738
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Entity Type | Individual
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Provider Name | GABRIEL ILLOVSKY CRNA
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Gender | Male
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Dates
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Enumeration Date | 04/15/2022
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Last Update Date | 08/05/2022
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Provider Practice Location Address
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Address Line | 901 W BEN WHITE BLVD
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City | AUSTIN
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State | TX
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Zip | 78704-6903
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Country | US
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Telephone | 512-447-2211
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Fax |
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Provider Business Mailing Address
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Address Line | 312 W ELTING ST
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City | MACOMB
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State | IL
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Zip | 61455-1132
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Country | US
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Telephone | 309-259-9090
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 1071166
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 1071166
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License Number State | TX
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