Provider Demographics
NPI:1538117445
Name:MARAGOS, MARY E (MSN,APRN,FNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:MARAGOS
Suffix:
Gender:F
Credentials:MSN,APRN,FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4513 HARVEY AVENUE
Mailing Address - Street 2:
Mailing Address - City:WESTERN SPRINGS
Mailing Address - State:IL
Mailing Address - Zip Code:60558
Mailing Address - Country:US
Mailing Address - Phone:708-246-4421
Mailing Address - Fax:815-740-4243
Practice Address - Street 1:500 WILCOX ST
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-6169
Practice Address - Country:US
Practice Address - Phone:815-740-3815
Practice Address - Fax:815-740-4243
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily