Provider Demographics
NPI:1578533485
Name:BASS, MARLA E (DNP)
Entity Type:Individual
Prefix:
First Name:MARLA
Middle Name:E
Last Name:BASS
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:MARLA
Other - Middle Name:E
Other - Last Name:GOLDSMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DNP
Mailing Address - Street 1:29373 NETWORK PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-1293
Mailing Address - Country:US
Mailing Address - Phone:847-390-5900
Mailing Address - Fax:847-390-4757
Practice Address - Street 1:1875 DEMPSTER ST STE 180
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1144
Practice Address - Country:US
Practice Address - Phone:844-725-5238
Practice Address - Fax:847-723-2791
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR-184133-6363LF0000X
IL209-004700363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily