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:
Map and Directions

Health care specialties

SpecialtyCodeLicense #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 8 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.

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Identifiers

StateTypeNumberIssuer
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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