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General NPI Number Information
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NPI Number | 1134993181
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Entity Type | Individual
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Provider Name | JACQUELINE MARCIEL FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 11/09/2023
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Last Update Date | 10/18/2024
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Provider Practice Location Address
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Address Line | 901 BIESTERFIELD RD STE 203
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City | ELK GROVE VILLAGE
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State | IL
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Zip | 60007-7300
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Country | US
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Telephone | 847-262-4300
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Fax | 847-805-3860
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Provider Business Mailing Address
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Address Line | 641 ELIZABETH DR
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City | WOOD DALE
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State | IL
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Zip | 60191-2334
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Country | US
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Telephone | 630-542-3414
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 209.025897
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License Number State | IL
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