Healthcare Provider Details

I. General information

NPI: 1942401294
Provider Name (Legal Business Name): MARLENE TANG APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 08/23/2025
Certification Date: 08/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 W LAKE ST UNIT 15
BLOOMINGDALE IL
60108-1020
US

IV. Provider business mailing address

132 W LAKE ST UNIT 15
BLOOMINGDALE IL
60108-1020
US

V. Phone/Fax

Practice location:
  • Phone: 847-410-9018
  • Fax: 941-200-3938
Mailing address:
  • Phone: 847-410-9018
  • Fax: 941-200-3938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number277000227
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number277000227
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number277.000227
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: