Individual
MARISSA MALLINCKRODT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
505 SKOKIE BLVD, WILMETTE, IL 60091-2131
(847) 893-1020
Mailing address
505 SKOKIE BLVD, WILMETTE, IL 60091-2131
(847) 893-1020
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
209.033716
IL
Other
Enumeration date
10/29/2025
Last updated
10/29/2025
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