Provider Demographics
NPI:1326071333
Name:ORTH, MARY LOUISE (APN)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:LOUISE
Last Name:ORTH
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4667 W PRATT AVE
Mailing Address - Street 2:
Mailing Address - City:LINCOLNWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60712-3348
Mailing Address - Country:US
Mailing Address - Phone:847-675-2713
Mailing Address - Fax:312-413-4410
Practice Address - Street 1:1945 W WILSON AVE STE 4000
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-5255
Practice Address - Country:US
Practice Address - Phone:773-736-6220
Practice Address - Fax:773-736-3941
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL209002088363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics