Provider Demographics
NPI:1700363827
Name:GEDUTIS, GINA T (APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:T
Last Name:GEDUTIS
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:
Other - Last Name:CHRNKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN, FNP-C
Mailing Address - Street 1:16519 S ROUTE 59
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60586-2607
Mailing Address - Country:US
Mailing Address - Phone:630-646-5020
Mailing Address - Fax:630-646-5025
Practice Address - Street 1:16519 S ROUTE 59
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60586-2606
Practice Address - Country:US
Practice Address - Phone:630-646-5020
Practice Address - Fax:630-646-5025
Is Sole Proprietor?:No
Enumeration Date:2018-07-21
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.017780363LF0000X
IL277001729363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily