Mary E Gibson, APN

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

209-000390 Issued in IL

Practice address

4749 Lincoln Mall Dr Ste 204
Matteson, IL 60443-3806

Phone

(708) 481-4200

Fax

(708) 481-3320

NPI assigned

Jun 5, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• P C Goodwin Medical LLC

  • Internal Medicine Physician
  • Evergreen Park, IL
  • NPI 1013110444
  NPD (past)
• Primary Care Partners LLC

  • Internal Medicine Physician
  • Tinley Park, IL
  • NPI 1376533380
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149465600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1573776000000",
    "number": "1699714907",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7804 W GOLF DR APT 2B",
            "city": "PALOS HEIGHTS",
            "state": "IL",
            "postal_code": "604633067",
            "telephone_number": "708-481-4200",
            "fax_number": "708-481-3302"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4749 LINCOLN MALL DR STE 204",
            "city": "MATTESON",
            "state": "IL",
            "postal_code": "604433806",
            "telephone_number": "708-481-4200",
            "fax_number": "708-481-3320"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GIBSON",
        "first_name": "MARY",
        "middle_name": "E",
        "credential": "APN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-05",
        "last_updated": "2019-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": "209-000390",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "IL",
            "license": "209-000390",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUESHIELD NUMBER",
            "identifier": "01619268",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Debbie Gardner
• Janet Marie Gardner, LCSW
• Generations at Applewood, LLC
• Generations at Applewood, LLC
• Jennifer M Gerry
• Gifted Hands Home Healthcare Inc.
• Monika Gil, OD
• Tashanna Gillenwater, ED.D
• Reaelma N/a Gipson, PMHNP
• Andrea Glenn

• Adult Health Nurse Practitioner in Matteson, IL
• Providers in Matteson, IL by specialty
• Adult Health Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.