Individual
MRS. MARLA JO VANVICKLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APN
Contact information
Practice address
4215 NEWBURG RD, ROCKFORD, IL 61108-6479
(815) 988-8500
(815) 977-5956
Mailing address
4215 NEWBURG RD, ROCKFORD, IL 61108-6479
(815) 988-8500
(815) 977-5956
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
277003985
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0
NO NUMBER
—
Enumeration date
01/02/2021
Last updated
03/12/2025
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