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General NPI Number Information
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NPI Number | 1326071333
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Entity Type | Individual
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Provider Name | MARY LOUISE ORTH APN
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Gender | Female
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Dates
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Enumeration Date | 07/10/2006
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Last Update Date | 12/02/2021
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Provider Practice Location Address
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Address Line | 1945 W WILSON AVE STE 4000
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City | CHICAGO
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State | IL
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Zip | 60640-5255
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Country | US
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Telephone | 773-736-6220
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Fax | 773-736-3941
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Provider Business Mailing Address
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Address Line | 4667 W PRATT AVE
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City | LINCOLNWOOD
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State | IL
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Zip | 60712-3348
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Country | US
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Telephone | 847-675-2713
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Fax | 312-413-4410
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 209002088
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License Number State | IL
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