Healthcare Provider Details

I. General information

NPI: 1205261682
Provider Name (Legal Business Name): GINA MARIE MARCIN A.P.N., C.N.M., L.AC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2013
Last Update Date: 03/16/2022
Certification Date: 03/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1051 W RAND RD STE 101
ARLINGTON HEIGHTS IL
60004-2315
US

IV. Provider business mailing address

1051 W RAND RD STE 101
ARLINGTON HEIGHTS IL
60004-2315
US

V. Phone/Fax

Practice location:
  • Phone: 847-221-4900
  • Fax: 847-221-4996
Mailing address:
  • Phone: 847-221-4900
  • Fax: 847-221-4996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number198.000527
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number209.010580
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: