Provider Demographics
NPI:1477952729
Name:MARKS, NICOLE THERESE (APN, FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:THERESE
Last Name:MARKS
Suffix:
Gender:F
Credentials:APN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4789 ROUTE 71
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:IL
Mailing Address - Zip Code:60543-7415
Mailing Address - Country:US
Mailing Address - Phone:630-692-5730
Mailing Address - Fax:630-692-5731
Practice Address - Street 1:4789 ROUTE 71
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:IL
Practice Address - Zip Code:60543-7415
Practice Address - Country:US
Practice Address - Phone:630-692-5730
Practice Address - Fax:630-692-5731
Is Sole Proprietor?:No
Enumeration Date:2014-08-21
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL277000824363LF0000X
IL041.386240163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse