Healthcare Provider Details

I. General information

NPI: 1538830740
Provider Name (Legal Business Name): LINA GERTRUDE MARCHESCHI APRN, AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2021
Last Update Date: 10/29/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 N SAINT CLAIR ST FL 17
CHICAGO IL
60611-5975
US

IV. Provider business mailing address

675 N SAINT CLAIR ST FL 17
CHICAGO IL
60611-5975
US

V. Phone/Fax

Practice location:
  • Phone: 312-695-3800
  • Fax: 312-695-3644
Mailing address:
  • Phone: 312-695-3800
  • Fax: 312-695-3644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209024054
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number209024054
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: