Provider Demographics
NPI:1679558886
Name:GORTOWSKI, DEBORAH (NP)
Entity type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:
Last Name:GORTOWSKI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MISS
Other - First Name:DEBORAH
Other - Middle Name:
Other - Last Name:BICKEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:144 NORTH CT
Mailing Address - Street 2:
Mailing Address - City:DIXON
Mailing Address - State:IL
Mailing Address - Zip Code:61021-1224
Mailing Address - Country:US
Mailing Address - Phone:815-285-5347
Mailing Address - Fax:815-285-8928
Practice Address - Street 1:144 NORTH CT
Practice Address - Street 2:
Practice Address - City:DIXON
Practice Address - State:IL
Practice Address - Zip Code:61021-1224
Practice Address - Country:US
Practice Address - Phone:815-285-5437
Practice Address - Fax:815-285-8928
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209001773363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL334563199001Medicaid
IL209001773OtherSTATE LICENSE