Provider Demographics
NPI:1235802976
Name:CHEAIB, MARIAM M (NP-C)
Entity Type:Individual
Prefix:
First Name:MARIAM
Middle Name:M
Last Name:CHEAIB
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 W HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-3106
Mailing Address - Country:US
Mailing Address - Phone:800-226-2371
Mailing Address - Fax:
Practice Address - Street 1:1520 W HARRISON ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-3106
Practice Address - Country:US
Practice Address - Phone:800-226-2371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-28
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704314169363L00000X
WI11397363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner