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NPI Code Detail

MEDICARE: MARIE RODRIGUEZ RN

MEDICARE: MARIE RODRIGUEZ RN
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
1363LA2200XAdult Health Nurse Practitioner71005662IN
2363LG0600XGerontology Nurse Practitioner71005662IN
3363LG0600XGerontology Nurse Practitioner209.025497IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
171005662OTHERINLICENSE

General Provider Information

NPI Number : 1982990149
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARIE RODRIGUEZ RN
Provider Business Mailing Address
First Line : PO BOX 746721
Second Line :
City : ATLANTA
State : GA
Zip : 30374-6721
Country : US
Telephone Number : 733-521-5157
Fax Number : 312-929-0373
Provider Business Practice Location Address
First Line : 4318 S STATE ST
Second Line :
City : CHICAGO
State : IL
Zip : 60609-3701
Country : US
Telephone Number : 773-285-9304
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/24/2011
Last Update Date : 02/18/2025

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