MEDICARE: REBECCA MARVIN RN

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	163W00000X	Registered Nurse	041-301669	IL

General Provider Information

NPI Number	:	1194846857
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA MARVIN RN

Provider Business Mailing Address
First Line	:	4001 W DAYTON ST
Second Line	:
City	:	MCHENRY
State	:	IL
Zip	:	60050-8377
Country	:	US
Telephone Number	:	815-575-4979
Fax Number	:

Provider Business Practice Location Address
First Line	:	4001 W DAYTON ST
Second Line	:
City	:	MCHENRY
State	:	IL
Zip	:	60050-8377
Country	:	US
Telephone Number	:	815-575-4979
Fax Number	:	815-337-5510

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

Provider Enumeration Date	:	04/02/2007
Last Update Date	:	05/24/2013

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