Doctor Name: | GAYLIN MANION |
NPI Number: | 1023497591 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | FNP |
License Number: | 209012822 |
Business Practice Address: | 2900 Frank Scott Pkwy W Suite 904 Belleville, IL - 622235000 |
Business Phone Number: | 6182340640 |
Business Fax Number: | |
Mailing Address: | 2900 Frank Scott Pkwy W, Suite 904 BELLEVILLE |
State: | IL |
Postal Code: | 622235000 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 05/29/2015 |
NPI Last Update Date: | 05/29/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 209012822 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |