Healthcare Provider Details

I. General information

NPI: 1013786466
Provider Name (Legal Business Name): MONIKA MARRERO APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2023
Last Update Date: 01/31/2024
Certification Date: 01/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2650 RIDGE AVE
EVANSTON IL
60201-1781
US

IV. Provider business mailing address

8716 SCHOOL ST # 2
MORTON GROVE IL
60053-2923
US

V. Phone/Fax

Practice location:
  • Phone: 847-425-6400
  • Fax:
Mailing address:
  • Phone: 773-520-0136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209028708
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number209028708
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: