Provider Demographics
NPI:1558595934
Name:WASHINGTON, MARCIA (APRN)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 DES PLAINES AVE
Mailing Address - Street 2:SUITE 307
Mailing Address - City:FOREST PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60130-1470
Mailing Address - Country:US
Mailing Address - Phone:708-785-7853
Mailing Address - Fax:
Practice Address - Street 1:417 DES PLAINES AVE UNIT 196
Practice Address - Street 2:
Practice Address - City:FOREST PARK
Practice Address - State:IL
Practice Address - Zip Code:60130-4411
Practice Address - Country:US
Practice Address - Phone:630-886-6832
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-13
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209013589363LP0808X
IL038011393111N00000X
IL209.613589363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No111N00000XChiropractic ProvidersChiropractor
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily