Healthcare Provider Details

I. General information

NPI: 1952110595
Provider Name (Legal Business Name): MARY MARGUERITE MANSEAU APN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2025
Last Update Date: 10/31/2025
Certification Date: 10/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 S WASHINGTON ST INTENSIVE CARE UNIT
NAPERVILLE IL
60540-7499
US

IV. Provider business mailing address

2650 RIDGE AVE STE 1223
EVANSTON IL
60201-1700
US

V. Phone/Fax

Practice location:
  • Phone: 630-527-3000
  • Fax: 630-527-3581
Mailing address:
  • Phone: 847-982-3715
  • Fax: 847-982-3394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209031964
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number041.402094
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: