Healthcare Provider Details

I. General information

NPI: 1740552231
Provider Name (Legal Business Name): MARSHA F. TEODORI MSN, RN, CDE, CCRC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2012
Last Update Date: 05/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 W HARRISON ST STE 250
CHICAGO IL
60612-3861
US

IV. Provider business mailing address

1725 W HARRISON ST STE 250
CHICAGO IL
60612-3861
US

V. Phone/Fax

Practice location:
  • Phone: 312-563-2094
  • Fax: 312-563-2096
Mailing address:
  • Phone: 312-563-2094
  • Fax: 312-563-2096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number041288966
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number621586
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number933479
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: