Provider Demographics
NPI:1275954117
Name:RHODES, MARY T (FNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:T
Last Name:RHODES
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6195 W. 115TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:ALSIP
Mailing Address - State:IL
Mailing Address - Zip Code:60803-3703
Mailing Address - Country:US
Mailing Address - Phone:312-262-7002
Mailing Address - Fax:312-262-7005
Practice Address - Street 1:6195 W. 115TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:ALSIP
Practice Address - State:IL
Practice Address - Zip Code:60803-6080
Practice Address - Country:US
Practice Address - Phone:312-262-7002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-19
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209010983363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL$$$$$$$$$Medicaid