1386824597 NPI number — MARLYN D HIRSCH A.P.N.

Table of content: MARLYN D HIRSCH A.P.N. (NPI 1386824597)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386824597 NPI number — MARLYN D HIRSCH A.P.N.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HIRSCH
Provider First Name:
MARLYN
Provider Middle Name:
D
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
A.P.N.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386824597
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/22/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2565 S. KING DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60616
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
312-808-7201
Provider Business Mailing Address Fax Number:
708-516-4777

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2565 KING DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60616
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-808-7201
Provider Business Practice Location Address Fax Number:
708-516-4777
Provider Enumeration Date:
11/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163WG0000X , with the licence number:  041300563 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 164W00000X , with the licence number: 209006984 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 209006984 . This is a "ADVANCED PRACTICE NURSE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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