MARY E GIBSON (NPI# 1699714907) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1699714907 |
| Entity Type | Individual |
| Full Name | MARY E GIBSON |
| Credential | APN |
| Practice Address |
4749 Lincoln Mall Dr Ste 204 Matteson IL 60443-3806 |
| Mailing Address |
7804 W Golf Dr Apt 2b Palos Heights IL 60463-3067 |
| Practice Telephone | 7084814200 |
| Practice Fax Number | 7084813320 |
| Mailing Telephone | 7084814200 |
| Mailing Fax Number | 7084813302 |
| Enumeration Date | 2006-06-05 |
| Last Update Date | 2019-11-15 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363L00000X | Nurse Practitioner | 209-000390 | IL | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 363LA2200X |
Nurse Practitioner Specialization: Adult Health |
209-000390 | IL | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | BLUESHIELD NUMBER | 01619268 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417509662 | Mary Yvette Gibson | Physical Therapy Assistant | 307 Boush St, Roper, NC 27970 | 2019-07-09 |
| 1184003782 | Mary Gibson | Social Worker | 25 Hudson Street, Kinderhook, NY 12106-0543 | 2015-05-28 |
| 1104148030 | Mary Gibson | Nurse's Aide | 2616 Vance Ave, Wheeling, WV 26003-7240 | 2010-02-19 |
| 1912176090 | Mary Hope Gibson | Nurse Practitioner | Moffett Hall Adams Street, Radford University Student Health, Radford, VA 24142 | 2008-02-22 |
| 1033774286 | Mary Gibson | Pharmacist | 1920 S Chelton Rd, Colorado Springs, CO 80916-5304 | 2019-05-03 |
| 1922583434 | Mary Celeste Gibson | Counselor | 9938 Airline Hwy, Baton Rouge, LA 70816-8193 | 2018-10-01 |
| 1114380920 | Mary Gibson | Counselor | 1088 Wasserman Way, Suite C, Batavia, OH 45103-1974 | 2016-03-30 |
| 1205216579 | Mary Elizabeth Gibson | Orthopaedic Surgery | 1222 S Orange Ave, 5th Floor, Orlando, FL 32806-1215 | 2015-06-02 |
| 1942631874 | Mary Gibson | Registered Nurse | 700 S Parker Dr, Suite 7, Florence, SC 29501-6059 | 2013-12-03 |
| 1588098701 | Mary Cantrell Gibson | Counselor | 8931 Huron St, Thornton, CO 80260-6806 | 2013-08-23 |
| Street Address |
4749 LINCOLN MALL DR STE 204 |
| City | MATTESON |
| State | IL |
| Zip Code | 60443-3806 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811996036 | William B Evans | Internal Medicine | 4749 Lincoln Mall Dr Ste 204, Matteson, IL 60443-3806 | 2005-07-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821642497 | Natalie Donyelle Mitchell | Psychologist | 6202 Vollmer Rd Colin Powell Middle School, Elementary Sd 159, Matteson, IL 60443 | 2019-07-31 |
| 1881199909 | Christopher Anthony Smith | Student in an Organized Health Care Education/Training Program | 5660 Woodgate Dr, Matteson, IL 60443 | 2018-03-29 |
| 1336695253 | Renato Leano | Physical Therapist | 21020 Kostner Avenue, Matteson, IL 60443 | 2016-08-31 |
| 1669826657 | Heredeshee Latrice Taylor | Nurse Practitioner | 3201 Holden Cir, Matteson, IL 60443 | 2016-04-16 |
| 1366713125 | Rosanne Miller Tadsen | Counselor | 6201 Vollmer Rd, Matteson, IL 60443 | 2012-01-25 |
| 1598063281 | Sheri Temple | Occupational Therapist | 3906 212th Place, Matteson, IL 60443 | 2011-03-04 |
| 1013247576 | Sheila M. Pijus | Counselor | 336 Tullamore Ter., Matteson, IL 60443 | 2010-01-06 |
| 1962731190 | Benita Yvette Norwoord | Counselor | 600 Holiday Plaza, Matteson, IL 60443 | 2009-12-17 |
| 1386881654 | Reliance Home Health Services, Inc. | Home Health | 4350 W. Lincoln Hwy #210, Reliance Home Health Services, Inc., Matteson, IL 60443 | 2009-01-08 |
| 1518139286 | Walgreen Co. | Durable Medical Equipment & Medical Supplies | 5640 211th St., Matteson, IL 60443 | 2008-04-02 |
| Find all providers in zip 60443 | ||||
| Taxonomy Code | 363LA2200X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Adult Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851998553 | Melissa Litwin | Nurse Practitioner | 9127 Burlington Ave, Brookfield, IL 60513-1939 | 2020-10-06 |
| 1932724200 | Tatyana Menaker | Nurse Practitioner | 2958 West Devon Ave, Chicago, IL 60659 | 2020-06-12 |
| 1518506625 | Lila Macalinga Rivera | Nurse Practitioner | 17w335 16th St, Oakbrook Terrace, IL 60181-4030 | 2020-01-06 |
| 1922642495 | Christine Nacar | Nurse Practitioner | 1232 Le Moyne Ave, Romeoville, IL 60446-4180 | 2019-10-29 |
| 1144871344 | Wensheng Tracy Wu | Nurse Practitioner | 1555 Barrington Rd Ste 1200, Hoffman Estates, IL 60169-5036 | 2019-09-27 |
| 1881245314 | Mkbb LLC | Nurse Practitioner | 1212 E Algonquin Rd, Algonquin, IL 60102-5446 | 2019-09-25 |
| 1225681455 | Jinu Joss | Nurse Practitioner | 9939 N Warren Oval, Niles, IL 60714-1044 | 2019-07-17 |
| 1659830057 | Ginger Dean | Nurse Practitioner | 2843 Chicago Rd, South Chicago Heights, IL 60411-4736 | 2019-03-15 |
| 1770048910 | Amanda K Honchell I | Nurse Practitioner | 401 W Madison St, Mount Carroll, IL 61053-9485 | 2019-02-01 |
| 1548725799 | Grace Nwaka Wabomnor | Nurse Practitioner | 17 E Grandview Dr, South Holland, IL 60473-1099 | 2019-02-01 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.