Provider Demographics
NPI:1235520560
Name:WALWEMA, MARIANNE EVE
Entity Type:Individual
Prefix:
First Name:MARIANNE
Middle Name:EVE
Last Name:WALWEMA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5496 S HYDE PARK BLVD
Mailing Address - Street 2:APT 908
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615-5831
Mailing Address - Country:US
Mailing Address - Phone:305-431-4594
Mailing Address - Fax:
Practice Address - Street 1:240 E HURON STREET, SUITE 1-200
Practice Address - Street 2:NORTHWESTERN MEDICINE MCGAW MEDICAL CENTER
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611
Practice Address - Country:US
Practice Address - Phone:312-503-7975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-09
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program