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General NPI Number Information
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NPI Number | 1063529717
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Entity Type | Individual
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Provider Name | MARY MCMANUS APRN
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Gender | Female
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Dates
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Enumeration Date | 08/25/2006
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Last Update Date | 03/21/2025
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Provider Practice Location Address
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Address Line | 1855 W IRVING PARK RD
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City | SCHAUMBURG
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State | IL
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Zip | 60193-3516
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Country | US
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Telephone | 866-389-2727
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Fax |
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Provider Business Mailing Address
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Address Line | 254 N PARK BLVD
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City | GLEN ELLYN
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State | IL
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Zip | 60137-5242
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Country | US
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Telephone | 630-290-3690
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Fax |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 277002750
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 209005389
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License Number State | IL
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