Provider Demographics
NPI:1558833699
Name:RAMIREZ, MARYBELL (MSN, FNP-C)
Entity Type:Individual
Prefix:MS
First Name:MARYBELL
Middle Name:
Last Name:RAMIREZ
Suffix:
Gender:F
Credentials:MSN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2440 S LARAMIE AVE UNIT 50646
Mailing Address - Street 2:
Mailing Address - City:CICERO
Mailing Address - State:IL
Mailing Address - Zip Code:60804-5147
Mailing Address - Country:US
Mailing Address - Phone:708-320-1510
Mailing Address - Fax:773-847-4467
Practice Address - Street 1:1406 S CHESTNUT DR
Practice Address - Street 2:
Practice Address - City:MOUNT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056-4520
Practice Address - Country:US
Practice Address - Phone:708-628-4520
Practice Address - Fax:773-847-4467
Is Sole Proprietor?:No
Enumeration Date:2018-12-31
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209018579363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036100946Medicaid