Provider Demographics
NPI:1164890869
Name:GAYNOR, MARGARET M (APRN, CNP)
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:M
Last Name:GAYNOR
Suffix:
Gender:F
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4309 W MEDICAL CENTER DR STE B301
Mailing Address - Street 2:
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050-8439
Mailing Address - Country:US
Mailing Address - Phone:847-802-7400
Mailing Address - Fax:815-759-4375
Practice Address - Street 1:4309 W MEDICAL CENTER DR STE B301
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-8439
Practice Address - Country:US
Practice Address - Phone:847-802-7400
Practice Address - Fax:815-759-4375
Is Sole Proprietor?:No
Enumeration Date:2015-09-11
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.256894363LG0600X
IL209013236363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF400250872Medicare PIN