Bolanowski, Marybeth

Bolanowski, Marybeth is an individual health care provider with primary practice located at 1801 S Highland Ave Ste 220 , Lombard IL 60148-4932. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Surgical, Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant. Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant is her primary health care specialty. Bolanowski, Marybeth can be contacted via phone (630) 790-1872.

Contact Information

Primary practice address
1801 S Highland Ave Ste 220 Lombard IL 60148-4932
Phone: (630) 790-1872
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Surgical 363AS0400X 085001424 Illinois
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 085001424 Illinois

Profile Details

NPI number 1891781639
LBN Legal business name Bolanowski, Marybeth
Credentials Physician Assistant (PA)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 27th, 2005
Last updated Jun 27th, 2023 - about 2 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 1891781639 NPPES
Illinois Other 970023229 RAILROAD MEDICARE
Illinois MEDICAID 085001424 RAILROAD MEDICARE

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