Gillian Rachel Brown, ATC
Individual provider Active NPI Athletic Trainer · Mendota, IL
NPI 1033609102 · NPPES record last updated May 15, 2018
Key facts
- NPI
- 1033609102
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Athletic Trainer 2255A2300X
- Practice address
- 400 16TH St
Mendota, IL 61342-1228 - Phone
- (815) 766-1164
- NPI assigned
- May 15, 2018
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | IA | Yes |
Addresses
Primary practice location
400 16TH St
Mendota, IL 61342-1228
Mailing address
400 16TH St
Mendota, IL 61342-1228
Other providers in Mendota, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 15, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.