Provider Demographics
NPI:1194993329
Name:NORD, GINA ROSE BATHURST (MD)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:ROSE BATHURST
Last Name:NORD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1905 WAKEFIELD LN
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61704-9197
Mailing Address - Country:US
Mailing Address - Phone:214-709-7568
Mailing Address - Fax:469-277-3190
Practice Address - Street 1:1105 CENTRAL EXPY N
Practice Address - Street 2:SUITE 375
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-6103
Practice Address - Country:US
Practice Address - Phone:972-747-5830
Practice Address - Fax:972-747-5841
Is Sole Proprietor?:No
Enumeration Date:2008-02-11
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN7777207L00000X
IL036137448207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology