Healthcare Provider Details

I. General information

NPI: 1669689584
Provider Name (Legal Business Name): JULIE R MARSHALL R.N., A.P.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 08/07/2019
Certification Date:
Deactivation Date: 07/27/2019
Reactivation Date: 08/07/2019

III. Provider practice location address

6636 RIDGE ROAD
DARIEN IL
60561
US

IV. Provider business mailing address

6636 RIDGE ROAD
DARIEN IL
60561
US

V. Phone/Fax

Practice location:
  • Phone: 630-863-3754
  • Fax: 630-789-9093
Mailing address:
  • Phone: 630-863-3754
  • Fax: 630-789-9093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041-190862
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number9387-33
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number209-005927
License Number StateIL
# 4
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number209.018852
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: