Healthcare Provider Details

I. General information

NPI: 1376669192
Provider Name (Legal Business Name): REBECCA MARANO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 07/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2875 W. 19TH STREET
CHICAGO IL
60623
US

IV. Provider business mailing address

2740 N PINE GROVE AVE APT 15A
CHICAGO IL
60614-6616
US

V. Phone/Fax

Practice location:
  • Phone: 773-484-4366
  • Fax:
Mailing address:
  • Phone: 773-858-5562
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number209006158
License Number StateIL

VIII. Authorized Official

Name: ROSEMARY MEGANCK
Title or Position: DIRECTOR
Credential: APN
Phone: 773-484-4366