Provider Demographics
NPI:1487089306
Name:GURGANUS, NASTASSIA MARIE (MS, FNP-BC, MPH)
Entity type:Individual
Prefix:MS
First Name:NASTASSIA
Middle Name:MARIE
Last Name:GURGANUS
Suffix:
Gender:F
Credentials:MS, FNP-BC, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 N KINGSBURY ST
Mailing Address - Street 2:#1167
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-7432
Mailing Address - Country:US
Mailing Address - Phone:931-216-5746
Mailing Address - Fax:
Practice Address - Street 1:5841 S MARYLAND AVE
Practice Address - Street 2:MC 5028
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-1447
Practice Address - Country:US
Practice Address - Phone:773-702-8344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-10
Last Update Date:2013-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041406330163W00000X
IL209010746363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse