MEDICARE: MARIOLA TRABA APN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP2300X	Primary Care Nurse Practitioner	209.020530	IL
2	363LF0000X	Family Nurse Practitioner	209.020530	IL

General Provider Information

NPI Number	:	1164060117
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIOLA TRABA APN

Provider Business Mailing Address
First Line	:	5545 N MILWAUKEE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60630-1226
Country	:	US
Telephone Number	:	773-792-8181
Fax Number	:

Provider Business Practice Location Address
First Line	:	5545 N MILWAUKEE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60630-1226
Country	:	US
Telephone Number	:	773-792-8181
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/19/2019
Last Update Date	:	04/13/2020

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Directions to “ MARIOLA TRABA APN” Practice Location

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