Individual
MARIPAT LAMP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APN
Contact information
Practice address
25 N WINFIELD RD, SUITE 501, WINFIELD, IL 60190-1295
(630) 933-4056
Mailing address
25 N WINFIELD RD, SUITE 501, WINFIELD, IL 60190-1295
(630) 933-4056
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
041250368
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
206147
MEDICARE PTAN (GROUP)
—
01
—
206147072
MEDICARE PTAN (INDIVIDUAL)
—
01
—
3631498336019001
CDPG HFS PAYEE ID
IL
Enumeration date
06/26/2008
Last updated
05/14/2013
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