MEDICARE: MARY LOUISE ORTH 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	363LP0200X	Pediatric Nurse Practitioner	209002088	IL

General Provider Information

NPI Number	:	1326071333
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY LOUISE ORTH APN

Provider Business Mailing Address
First Line	:	4667 W PRATT AVE
Second Line	:
City	:	LINCOLNWOOD
State	:	IL
Zip	:	60712-3348
Country	:	US
Telephone Number	:	847-675-2713
Fax Number	:	312-413-4410

Provider Business Practice Location Address
First Line	:	1945 W WILSON AVE STE 4000
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-5255
Country	:	US
Telephone Number	:	773-736-6220
Fax Number	:	773-736-3941

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

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	12/02/2021

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Directions to “ MARY LOUISE ORTH APN” Practice Location

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