Provider Demographics
NPI:1962413112
Name:GIFFORD, JANET (NP)
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:
Last Name:GIFFORD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JANET
Other - Middle Name:
Other - Last Name:GIFFORD-FEFFER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:133 E BRUSH HILL RD STE 202
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-5661
Mailing Address - Country:US
Mailing Address - Phone:331-231-6200
Mailing Address - Fax:331-231-6201
Practice Address - Street 1:133 E BRUSH HILL RD STE 202
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-5661
Practice Address - Country:US
Practice Address - Phone:331-231-6200
Practice Address - Fax:331-231-6201
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-002700363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK25617Medicare ID - Type UnspecifiedLOCAL 15