Doctor Name: | GLORIA MUDRYJ |
NPI Number: | 1043624067 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MSN, APN |
License Number: | 209.011087 |
Business Practice Address: | 4440 W 95th St Oak Lawn, IL - 604532600 |
Business Phone Number: | 7086842153 |
Business Fax Number: | |
Mailing Address: | 19301 Weber Ct, MOKENA |
State: | IL |
Postal Code: | 604481166 |
Phone Number: | 7088990341 |
Fax Number: | |
NPI Enumeration Date: | 06/18/2014 |
NPI Last Update Date: | 06/18/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 209.011087 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |