Individual
MARGEAUX ARDIENTE GASTALA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
839 W 79TH ST, CHICAGO, IL 60620-2699
(312) 492-1220
Mailing address
839 W 79TH ST, CHICAGO, IL 60620-2699
(312) 492-1220
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
209016675
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1013422609
—
IL
Enumeration date
12/05/2017
Last updated
04/24/2024
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