Provider Demographics
NPI:1215060298
Name:GREATHOUSE, GAIL (FNP)
Entity type:Individual
Prefix:
First Name:GAIL
Middle Name:
Last Name:GREATHOUSE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 E LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:IL
Mailing Address - Zip Code:62450-2553
Mailing Address - Country:US
Mailing Address - Phone:618-395-7340
Mailing Address - Fax:
Practice Address - Street 1:100 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WEST SALEM
Practice Address - State:IL
Practice Address - Zip Code:62476-1202
Practice Address - Country:US
Practice Address - Phone:618-456-3727
Practice Address - Fax:618-456-3774
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209002292363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209-002292OtherLICENSE NUMBER