Provider Demographics
NPI:1386824597
Name:HIRSCH, MARLYN D (APN)
Entity Type:Individual
Prefix:
First Name:MARLYN
Middle Name:D
Last Name:HIRSCH
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2565 S. KING DRIVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616
Mailing Address - Country:US
Mailing Address - Phone:312-808-7201
Mailing Address - Fax:708-516-4777
Practice Address - Street 1:2565 KING DRIVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616
Practice Address - Country:US
Practice Address - Phone:312-808-7201
Practice Address - Fax:708-516-4777
Is Sole Proprietor?:No
Enumeration Date:2007-11-06
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041300563163WG0000X
IL209006984164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209006984OtherADVANCED PRACTICE NURSE