MEDICARE: MARY LUDVIGSEN N.P.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	0033192	OH
2	363LF0000X	Family Nurse Practitioner	209.003905	IL
3	363LF0000X	Family Nurse Practitioner	4704397286	MI
4	363LF0000X	Family Nurse Practitioner	F351485	NY
5	363LF0000X	Family Nurse Practitioner	71013806A	IN
6	363LF0000X	Family Nurse Practitioner	1467233	WI

General Provider Information

NPI Number	:	1194740514
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY LUDVIGSEN N.P.

Provider Business Mailing Address
First Line	:	75 REMITT DRIVE
Second Line	:	LOCKBOX 1374
City	:	CHICAGO
State	:	IL
Zip	:	60675-1374
Country	:	US
Telephone Number	:	866-916-5259
Fax Number	:	231-922-4030

Provider Business Practice Location Address
First Line	:	6831 NORTH AVE
Second Line	:
City	:	OAK PARK
State	:	IL
Zip	:	60302-1023
Country	:	US
Telephone Number	:	708-298-0540
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2006
Last Update Date	:	12/11/2023

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