Provider Demographics
NPI:1437345212
Name:MARSH, VANDA L (CPNP)
Entity Type:Individual
Prefix:MRS
First Name:VANDA
Middle Name:L
Last Name:MARSH
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 E LOOP RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-2038
Mailing Address - Country:US
Mailing Address - Phone:630-690-7300
Mailing Address - Fax:630-690-7335
Practice Address - Street 1:55 E LOOP RD
Practice Address - Street 2:SUITE 301
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-2038
Practice Address - Country:US
Practice Address - Phone:630-690-7300
Practice Address - Fax:630-690-7335
Is Sole Proprietor?:No
Enumeration Date:2007-09-14
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics