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General NPI Number Information
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NPI Number | 1124752092
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Entity Type | Individual
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Provider Name | LORI LYNN MAREK APN
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Gender | Female
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Dates
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Enumeration Date | 07/14/2022
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Last Update Date | 10/27/2022
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Provider Practice Location Address
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Address Line | 1335 N MILL ST
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City | NAPERVILLE
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State | IL
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Zip | 60563-2261
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Country | US
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Telephone | 630-646-8000
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Fax |
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Provider Business Mailing Address
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Address Line | 456 BUTTERFLY RD
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City | BOLINGBROOK
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State | IL
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Zip | 60490-4527
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Country | US
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Telephone | 630-301-9901
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 041-282572
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 209.025985
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License Number State | IL
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