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General NPI Number Information
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NPI Number | 1164395562
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Entity Type | Individual
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Provider Name | MARY WIRTH
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Gender | Female
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Dates
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Enumeration Date | 09/24/2025
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Last Update Date | 09/24/2025
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Provider Practice Location Address
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Address Line | 804 E WOODFIELD RD STE 300
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City | SCHAUMBURG
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State | IL
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Zip | 60173-4776
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Country | US
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Telephone | 847-605-9500
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Fax | 847-605-8700
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Provider Business Mailing Address
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Address Line | 3595 WATERSCAPE TER
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City | ELGIN
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State | IL
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Zip | 60124-5715
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Country | US
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Telephone | 224-465-2631
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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 | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 209033159
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 209033159
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License Number State | IL
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