Healthcare Provider Details

I. General information

NPI: 1821759333
Provider Name (Legal Business Name): MARIE C COGLEY MSN, APRN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2022
Last Update Date: 06/09/2023
Certification Date: 06/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 LUTHER LN STE 1170
PARK RIDGE IL
60068-1270
US

IV. Provider business mailing address

29373 NETWORK PL
CHICAGO IL
60673-3846
US

V. Phone/Fax

Practice location:
  • Phone: 844-376-3876
  • Fax: 847-723-2041
Mailing address:
  • Phone: 847-390-5900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0222X
TaxonomyCritical Care Pediatric Nurse Practitioner
License Number209-023749
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: