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NPI Code Detail

MEDICARE: MARCIA ANN STREET FNP-C

MEDICARE: MARCIA ANN STREET FNP-C
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
1207Q00000XFamily Medicine Physician209.018377IL

General Provider Information

NPI Number : 1861999344
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARCIA ANN STREET FNP-C
Provider Business Mailing Address
First Line : 500 S SCOTT AVE
Second Line :
City : NEWTON
State : IL
Zip : 62448-1665
Country : US
Telephone Number : 618-783-2144
Fax Number : 618-783-2541
Provider Business Practice Location Address
First Line : 500 S SCOTT AVE
Second Line :
City : NEWTON
State : IL
Zip : 62448-1665
Country : US
Telephone Number : 618-783-2144
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/10/2018
Last Update Date : 10/15/2018

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Directions to “ MARCIA ANN STREET FNP-C” Practice Location

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