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1669927893 NPI number — MARIE ANN KORALLUS RN, MSN, APRN,FNP-C

NPI Number: 1669927893
Health Care Provider/Practitioner: MARIE ANN KORALLUS RN, MSN, APRN,FNP-C

Information about “1669927893” NPI (MARIE ANN KORALLUS RN, MSN, APRN,FNP-C) exists in 1669927893 in HTML format HTML  |  1669927893 in plain Text format TXT  |  1669927893 in PDF (Portable Document Format) PDF  |  1669927893 in an XML format XML  formats.

NPI Number : 1669927893 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1669927893",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "KORALLUS",
    "FirstName": "MARIE ANN",
    "MiddleName": null,
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "RN, MSN, APRN,FNP-C",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "KORALLUS",
    "OtherFirstName": "MARIE",
    "OtherMiddleName": "ANN",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "APN",
    "OtherLastNameTypeCode": "2",
    "FirstLineMailingAddress": "6170 JOLIET RD STE 1",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "COUNTRYSIDE",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "60525-3971",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "708-352-0330",
    "MailingAddressFaxNumber": "708-352-8905",
    "FirstLinePracticeLocationAddress": "6170 JOLIET RD STE 1",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "COUNTRYSIDE",
    "PracticeLocationAddressStateName": "IL",
    "PracticeLocationAddressPostalCode": "60525-3971",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "708-352-0330",
    "PracticeLocationAddressFaxNumber": "708-352-8905",
    "EnumerationDate": "08/17/2016",
    "LastUpdateDate": "10/06/2022",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "363LF0000X",
        "TaxonomyName": "Family Nurse Practitioner",
        "LicenseNumber": "209.018644",
        "LicenseNumberStateCode": "IL",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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