Antman, Mariellen Patricia
Antman, Mariellen Patricia is an individual health care provider with primary practice located at 800 N Westmoreland Rd Suite 205, Lake Forest IL 60045-1673. She recently has 3 registered licenses in different health care specialties including Nursing Service Providers / Registered Nurse, Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner, Physician Assistants & Advanced Practice Nursing Providers / Adult Health. Physician Assistants & Advanced Practice Nursing Providers / Adult Health is her primary health care specialty. Antman, Mariellen Patricia can be contacted via phone (847) 735-8550.Contact Information
Primary practice address
800 N Westmoreland Rd Suite 205
Lake Forest IL 60045-1673
Phone: (847) 735-8550
Fax: (847) 535-8590
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Nursing Service Providers / Registered Nurse | 163W00000X | 041202000 | Illinois |
| Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner | 363L00000X | 209005116 | Illinois |
| Physician Assistants & Advanced Practice Nursing Providers / Adult Health | 363LA2200X | 209.005116 | Illinois |
Profile Details
| NPI number | 1235271941 |
|---|---|
| LBN Legal business name | Antman, Mariellen Patricia |
| Credentials | APN-CNP |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Feb 12th, 2007 |
| Last updated | Oct 13th, 2016 - about 10 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1235271941 | NPPES |
| Illinois | Other | IL6304003 | MEDICARE PTAN LOC 16 |
| Illinois | Other | IL6305003 | MEDICARE PTAN LOC 16 |
| Illinois | Other | 1720371669 | MEDICARE PTAN LOC 16 |
| Illinois | Other | P01058711 | MEDICARE PTAN LOC 16 |
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