Healthcare Provider Details

I. General information

NPI: 1548041544
Provider Name (Legal Business Name): MARY ALBERTS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2023
Last Update Date: 02/13/2026
Certification Date: 02/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 W 95TH ST
EVERGREEN PARK IL
60805-2701
US

IV. Provider business mailing address

2800 W 95TH ST
EVERGREEN PARK IL
60805-2701
US

V. Phone/Fax

Practice location:
  • Phone: 708-229-4007
  • Fax:
Mailing address:
  • Phone: 708-229-4007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209027117
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209027117
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: