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General NPI Number Information
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NPI Number | 1043845027
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Entity Type | Individual
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Provider Name | ROSS MAMARIL FNP
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Gender | Male
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Dates
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Enumeration Date | 03/10/2020
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Last Update Date | 03/10/2020
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Provider Practice Location Address
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Address Line | 4815 S WESTERN BLVD
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City | CHICAGO
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State | IL
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Zip | 60609-4067
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Country | US
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Telephone | 773-927-4200
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Fax |
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Provider Business Mailing Address
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Address Line | 5132 N ELSTON AVE
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City | CHICAGO
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State | IL
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Zip | 60630-2429
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Country | US
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Telephone | 847-235-6130
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Fax | 847-235-6135
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 209.020575
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License Number State | IL
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