Healthcare Provider Details

I. General information

NPI: 1013807445
Provider Name (Legal Business Name): BARBARA LEE MARRANDINO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2025
Last Update Date: 07/07/2025
Certification Date: 07/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

842 HANN AVE
DIXON IL
61021-9018
US

IV. Provider business mailing address

842 HANN AVE
DIXON IL
61021-9018
US

V. Phone/Fax

Practice location:
  • Phone: 815-590-3038
  • Fax: 815-590-3038
Mailing address:
  • Phone: 815-590-3038
  • Fax: 815-590-3038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number041.437848
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: