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NPI Code Detail

MEDICARE: MARY-KATHERINE MARSHALL

MEDICARE: MARY-KATHERINE MARSHALL
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
1363LP0200XPediatric Nurse Practitioner318088AZ
2363LP0200XPediatric Nurse Practitioner209.023794IL

General Provider Information

NPI Number : 1568127629
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY-KATHERINE MARSHALL
Provider Business Mailing Address
First Line : 1436 W HENDERSON ST APT 2
Second Line :
City : CHICAGO
State : IL
Zip : 60657-2170
Country : US
Telephone Number : 630-802-3752
Fax Number :
Provider Business Practice Location Address
First Line : 5721 S MARYLAND AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60637-1425
Country : US
Telephone Number : 888-824-0200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/03/2021
Last Update Date : 05/16/2025

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Directions to “ MARY-KATHERINE MARSHALL ” Practice Location

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