Healthcare Provider Details

I. General information

NPI: 1164044079
Provider Name (Legal Business Name): NATALIA MARCINKOWSKI APRN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2020
Last Update Date: 12/01/2023
Certification Date: 12/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 PATRIOT BLVD
GLENVIEW IL
60026-8039
US

IV. Provider business mailing address

2701 PATRIOT BLVD
GLENVIEW IL
60026-8039
US

V. Phone/Fax

Practice location:
  • Phone: 847-535-7647
  • Fax: 847-998-9733
Mailing address:
  • Phone: 847-535-7647
  • Fax: 847-998-9733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number423809
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number020266
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209020266
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: