MEDICARE: GAIL Y BRICK ANP

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	363LF0000X	Family Nurse Practitioner	209007292	IL

General Provider Information

NPI Number	:	1679724561
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GAIL Y BRICK ANP

Provider Business Mailing Address
First Line	:	2170 PEARL ST
Second Line	:
City	:	BELVIDERE
State	:	IL
Zip	:	61008-6020
Country	:	US
Telephone Number	:	815-547-5461
Fax Number	:	815-544-9681

Provider Business Practice Location Address
First Line	:	2170 PEARL ST
Second Line	:
City	:	BELVIDERE
State	:	IL
Zip	:	61008-6020
Country	:	US
Telephone Number	:	815-547-5461
Fax Number	:	815-544-9681

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

Provider Enumeration Date	:	10/09/2008
Last Update Date	:	07/08/2011

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Directions to “ GAIL Y BRICK ANP” Practice Location

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