Provider Demographics
NPI:1639442510
Name:MARASIGAN, AGATONA VILLEGAS (RN)
Entity Type:Individual
Prefix:MRS
First Name:AGATONA
Middle Name:VILLEGAS
Last Name:MARASIGAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:ANGIE
Other - Middle Name:VILLEGAS
Other - Last Name:MARASIGAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:3010 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:WAUKEGAN
Mailing Address - State:IL
Mailing Address - Zip Code:60085-2321
Mailing Address - Country:US
Mailing Address - Phone:847-377-8200
Mailing Address - Fax:847-360-7377
Practice Address - Street 1:3010 GRAND AVE
Practice Address - Street 2:
Practice Address - City:WAUKEGAN
Practice Address - State:IL
Practice Address - Zip Code:60085-2321
Practice Address - Country:US
Practice Address - Phone:847-377-8200
Practice Address - Fax:847-360-7377
Is Sole Proprietor?:No
Enumeration Date:2012-02-22
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.301662163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse