Provider Demographics
NPI:1518936400
Name:NAMOVICE, MARY L (RN)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:L
Last Name:NAMOVICE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:L
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:7730 HAWKS VIEW DR
Mailing Address - Street 2:
Mailing Address - City:MACHESNEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:61115-8258
Mailing Address - Country:US
Mailing Address - Phone:815-637-1550
Mailing Address - Fax:
Practice Address - Street 1:7730 HAWKS VIEW DR
Practice Address - Street 2:
Practice Address - City:MACHESNEY PARK
Practice Address - State:IL
Practice Address - Zip Code:61115-8258
Practice Address - Country:US
Practice Address - Phone:815-637-1550
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse