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General NPI Number Information
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NPI Number | 1528520665
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Entity Type | Individual
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Provider Name | MARK RON IBE SR. MSN, APRN, FNP-C
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Gender | Male
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Dates
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Enumeration Date | 04/05/2019
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Last Update Date | 01/13/2020
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Provider Practice Location Address
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Address Line | 6325 MAIN ST
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City | WOODRIDGE
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State | IL
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Zip | 60517-1357
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Country | US
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Telephone | 630-541-6773
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Fax |
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Provider Business Mailing Address
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Address Line | 9124 S SOMERSET LN
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City | WOODRIDGE
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State | IL
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Zip | 60517-7587
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Country | US
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Telephone | 630-699-0911
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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 | 209.018841
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License Number State | IL
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