Healthcare Provider Details

I. General information

NPI: 1184053415
Provider Name (Legal Business Name): MARSHANELLE HORNE APN,FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2013
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

246 E JANATA BLVD STE 130
LOMBARD IL
60148-5377
US

IV. Provider business mailing address

246 E JANATA BLVD SUITE 130
LOMBARD IL
60148-5377
US

V. Phone/Fax

Practice location:
  • Phone: 331-300-1440
  • Fax: 949-655-5827
Mailing address:
  • Phone: 331-300-1440
  • Fax: 949-655-5827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209010847
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: