MEDICARE: MRS. GINGER DEAN APRN

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
1	363LA2200X	Adult Health Nurse Practitioner	209019007	IL

General Provider Information

NPI Number	:	1659830057
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. GINGER DEAN APRN

Provider Business Mailing Address
First Line	:	PO BOX 2944
Second Line	:
City	:	COUNTRY CLUB HILLS
State	:	IL
Zip	:	60478-8944
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2843 CHICAGO RD
Second Line	:
City	:	SOUTH CHICAGO HEIGHTS
State	:	IL
Zip	:	60411-4736
Country	:	US
Telephone Number	:	708-441-2158
Fax Number	:	708-575-1669

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/15/2019
Last Update Date	:	01/09/2023

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