MEDICARE: MRS. MARINA DIANE SCHANKS NP-C

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	363L00000X	Nurse Practitioner	209007264041237430	IL

General Provider Information

NPI Number	:	1730325226
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARINA DIANE SCHANKS NP-C

Provider Business Mailing Address
First Line	:	1000 REMINGTON BLVD
Second Line	:	STE 100
City	:	BOLINGBROOK
State	:	IL
Zip	:	60440-4707
Country	:	US
Telephone Number	:	773-296-5019
Fax Number	:	773-296-8909

Provider Business Practice Location Address
First Line	:	836 WEST WELLINGTON AVENUE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-5193
Country	:	US
Telephone Number	:	773-296-5019
Fax Number	:	773-296-8909

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

Provider Enumeration Date	:	01/05/2009
Last Update Date	:	12/21/2016

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