Healthcare Provider Details

I. General information

NPI: 1689090201
Provider Name (Legal Business Name): MARIAN TENTLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2014
Last Update Date: 03/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

676 N SAINT CLAIR ST SUITE 850
CHICAGO IL
60611-2927
US

IV. Provider business mailing address

676 N SAINT CLAIR ST SUITE 850
CHICAGO IL
60611-2927
US

V. Phone/Fax

Practice location:
  • Phone: 312-695-4124
  • Fax: 312-695-6189
Mailing address:
  • Phone: 312-695-4124
  • Fax: 312-695-6189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number209011320
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: