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General NPI Number Information
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NPI Number | 1689750846
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Entity Type | Individual
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Provider Name | MARILYN E MACKOWIAK LINDEMAN RNC-ANP
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Gender | Female
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Dates
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Enumeration Date | 10/31/2006
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Last Update Date | 12/19/2012
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Provider Practice Location Address
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Address Line | 5841 S MARYLAND AVE
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City | CHICAGO
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State | IL
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Zip | 60637-1447
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Country | US
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Telephone | 773-702-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 1570 ASBURY AVE
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City | EVANSTON
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State | IL
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Zip | 60201-4173
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Country | US
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Telephone | 847-869-0698
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 41-136229
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 209-002173
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License Number State | IL
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