Individual
MARION TAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DNP
Contact information
Practice address
3880 SALEM LAKE DR STE F, LONG GROVE, IL 60047-5292
(847) 719-2220
(847) 719-2265
Mailing address
3880 SALEM LAKE DR STE F, LONG GROVE, IL 60047-5292
(847) 719-2220
(847) 719-2265
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
041.456357
IL
363LA2200X
Adult Health Nurse Practitioner
Primary
209025913
IL
363LF0000X
Family Nurse Practitioner
209.025913
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
209025913
—
IL
01
—
MT8489785
DEA
IL
Enumeration date
07/16/2020
Last updated
09/09/2024
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