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General NPI Number Information
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NPI Number | 1790487528
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Entity Type | Individual
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Provider Name | MARIAN MALLARI LPN
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Gender | Female
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Dates
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Enumeration Date | 03/17/2023
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Last Update Date | 03/17/2023
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Provider Practice Location Address
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Address Line | 3001 GREEN BAY RD
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City | NORTH CHICAGO
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State | IL
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Zip | 60064-3048
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Country | US
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Telephone | 253-343-2529
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Fax |
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Provider Business Mailing Address
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Address Line | 1463 HAZELWOOD CT
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City | GURNEE
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State | IL
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Zip | 60031-6354
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Country | US
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Telephone | 253-343-2529
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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 | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 043107419
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License Number State | IL
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