Provider Demographics
NPI:1568408995
Name:MARINO, HEATHER (CNP)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:MARINO
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 SALT CREEK LN STE 125
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-3041
Mailing Address - Country:US
Mailing Address - Phone:630-655-1177
Mailing Address - Fax:
Practice Address - Street 1:11 SALT CREEK LN STE 125
Practice Address - Street 2:
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-3041
Practice Address - Country:US
Practice Address - Phone:630-655-1177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL309-000882363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1617057OtherBLUE CROSS BLUE SHIELD
ILK17028Medicare PIN
ILP85676Medicare UPIN