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General NPI Number Information
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NPI Number | 1740709336
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Entity Type | Individual
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Provider Name | CHRISTIE JO GESIN APN
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Gender | Female
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Dates
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Enumeration Date | 09/14/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 535 ROXBURY RD
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City | ROCKFORD
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State | IL
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Zip | 61107-5076
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Country | US
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Telephone | 815-387-1717
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Fax | 815-387-1718
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Provider Business Mailing Address
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Address Line | 535 ROXBURY RD
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City | ROCKFORD
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State | IL
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Zip | 61107-5076
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Country | US
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Telephone | 815-387-1717
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Fax | 815-387-1718
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 209016515
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License Number State | IL
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