Healthcare Provider Details

I. General information

NPI: 1164746822
Provider Name (Legal Business Name): OLGA I MARRERO R.N., IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2010
Last Update Date: 03/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2233 W DIVISION ST
CHICAGO IL
60622-8151
US

IV. Provider business mailing address

3700 W HAYFORD ST
CHICAGO IL
60652-1320
US

V. Phone/Fax

Practice location:
  • Phone: 312-770-2883
  • Fax:
Mailing address:
  • Phone: 708-650-8076
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP1700X
TaxonomyPerinatal Registered Nurse
License Number041320946
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: