Provider Demographics
NPI:1154719821
Name:GAVIN, PATRICK JOSEPH (APN-BC)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:JOSEPH
Last Name:GAVIN
Suffix:
Gender:M
Credentials:APN-BC
Other - Prefix:MR
Other - First Name:PADRAIC
Other - Middle Name:SEOSAMH
Other - Last Name:O'GAWAIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APN-BC
Mailing Address - Street 1:478 E FAWN LN
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60074-2361
Mailing Address - Country:US
Mailing Address - Phone:708-275-6748
Mailing Address - Fax:
Practice Address - Street 1:478 E FAWN LN
Practice Address - Street 2:
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60074-2361
Practice Address - Country:US
Practice Address - Phone:708-275-6748
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-05
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.011843363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health