Healthcare Provider Details

I. General information

NPI: 1619429909
Provider Name (Legal Business Name): CHRISTY MARKS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTY L MARKS FNP

II. Dates (important events)

Enumeration Date: 11/02/2016
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 W HARRISON ST
CHICAGO IL
60612-3800
US

IV. Provider business mailing address

1650 W HARRISON ST
CHICAGO IL
60612-3800
US

V. Phone/Fax

Practice location:
  • Phone: 312-942-3326
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209014969
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71009098A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number34634
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209014969
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: