Provider Demographics
NPI:1477020345
Name:HALL, MARVA (FNP)
Entity Type:Individual
Prefix:MS
First Name:MARVA
Middle Name:
Last Name:HALL
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 1:29373 NETWORK PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-1293
Mailing Address - Country:US
Mailing Address - Phone:847-390-5900
Mailing Address - Fax:888-664-1191
Practice Address - Street 1:1441 BRANDING AVE STE 310
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-5624
Practice Address - Country:US
Practice Address - Phone:630-829-1084
Practice Address - Fax:630-829-1040
Is Sole Proprietor?:No
Enumeration Date:2018-10-30
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209018431363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily