Healthcare Provider Details

I. General information

NPI: 1720597990
Provider Name (Legal Business Name): MARIZTHEL LOYOLA GUIAB DNP, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARIZTHEL MARFORI LOYOLA DNP, FNP-C

II. Dates (important events)

Enumeration Date: 09/20/2017
Last Update Date: 09/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WESTBROOK CORPORATE CTR STE 300
WESTCHESTER IL
60154-5709
US

IV. Provider business mailing address

8042 KENTON AVE APT 2
SKOKIE IL
60076-3180
US

V. Phone/Fax

Practice location:
  • Phone: 877-906-9699
  • Fax:
Mailing address:
  • Phone: 848-391-6410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209016507
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: