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General NPI Number Information
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NPI Number | 1326380973
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Entity Type | Individual
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Provider Name | MARLENE PAQUALE C.P,N.P.
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Gender | Female
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Dates
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Enumeration Date | 03/21/2013
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Last Update Date | 03/21/2013
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Provider Practice Location Address
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Address Line | 680 N LAKE SHORE DR 123
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City | CHICAGO
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State | IL
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Zip | 60611-4546
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Country | US
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Telephone | 312-642-5515
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Fax | 312-642-0753
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Provider Business Mailing Address
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Address Line | 680 N LAKE SHORE DR 123
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City | CHICAGO
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State | IL
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Zip | 60611-4546
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Country | US
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Telephone | 312-642-5515
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Fax | 312-642-0753
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 209.003864
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License Number State | IL
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