Provider Demographics
NPI:1518291236
Name:MAROTTA, COLLEEN (CNM)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:MAROTTA
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 N YORK RD
Mailing Address - Street 2:102
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-2950
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:950 N YORK RD
Practice Address - Street 2:102
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-2950
Practice Address - Country:US
Practice Address - Phone:630-920-1347
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-28
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209012010367A00000X
IL041325195163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant