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NPI Code Detail

MEDICARE: ANNA GILBRETH

MEDICARE: ANNA GILBRETH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LP0200XPediatric Nurse Practitioner209016241IL

General Provider Information

NPI Number : 1467977561
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANNA GILBRETH
Provider Business Mailing Address
First Line : 2250 N ILLINOIS AVE
Second Line :
City : CARBONDALE
State : IL
Zip : 62901-5612
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2100 MADISON AVE
Second Line :
City : GRANITE CITY
State : IL
Zip : 62040-4713
Country : US
Telephone Number : 618-833-1691
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/09/2017
Last Update Date : 01/10/2022

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Directions to “ ANNA GILBRETH ” Practice Location

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