Individual
GAIL VIVIANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1 MEMORIAL DR, ALTON, IL 62002-6722
(618) 463-7311
Mailing address
3613 BUCKLAND CT, SWANSEA, IL 62226-7499
(618) 977-3263
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
041.385493
IL
163W00000X
Registered Nurse
2012037887
MO
363L00000X
Nurse Practitioner
209.01498
IL
363LF0000X
Family Nurse Practitioner
Primary
209.01498
IL
Other
Enumeration date
08/31/2016
Last updated
02/07/2017
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