Provider Demographics
NPI:1093228652
Name:TENEZACA, MARCIA (LNP)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:
Last Name:TENEZACA
Suffix:
Gender:F
Credentials:LNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9518 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60131-2717
Mailing Address - Country:US
Mailing Address - Phone:847-260-5532
Mailing Address - Fax:847-260-5721
Practice Address - Street 1:9518 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:FRANKLIN PARK
Practice Address - State:IL
Practice Address - Zip Code:60131-2717
Practice Address - Country:US
Practice Address - Phone:847-260-5532
Practice Address - Fax:847-260-5721
Is Sole Proprietor?:No
Enumeration Date:2017-11-06
Last Update Date:2017-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209016858363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner