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Individual

MRS. PHYLLIS GABBART

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
APRN

Contact information

Practice address
305 S ILLINOIS ST, BELLEVILLE, IL 62220-2133
(618) 235-1703
(618) 222-5969
Mailing address
305 S ILLINOIS ST, BELLEVILLE, IL 62220-2133
(618) 235-1703
(618) 222-5969

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
04112574
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0000304010
GROUP IL MEDICARE
IL
01
K37461
IL MEDICARE
IL
Enumeration date
10/12/2006
Last updated
06/24/2016
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