Individual
MARIELLEN PATRICIA ANTMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APN-CNP
Contact information
Practice address
800 N WESTMORELAND RD, SUITE 205, LAKE FOREST, IL 60045-1673
(847) 735-8550
(847) 535-8590
Mailing address
251 E HURON ST, CHICAGO, IL 60611-2908
(847) 735-8550
(847) 535-8590
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
041202000
IL
363L00000X
Nurse Practitioner
209005116
IL
363LA2200X
Adult Health Nurse Practitioner
Primary
209.005116
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1720371669
NPI GROUP PRACTICE
IL
01
—
IL6304003
MEDICARE PTAN LOC 16
IL
01
—
IL6305003
MEDICARE PTAN LOC 15
IL
01
—
P01058711
RRMC PTAN
IL
Enumeration date
02/12/2007
Last updated
10/13/2016
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