Provider Demographics
NPI:1689441099
Name:PEREZ, MARILYN (NP-C)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:
Last Name:PEREZ
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 N LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801-2432
Mailing Address - Country:US
Mailing Address - Phone:217-383-3507
Mailing Address - Fax:217-383-3171
Practice Address - Street 1:610 N LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61801-2432
Practice Address - Country:US
Practice Address - Phone:217-383-3507
Practice Address - Fax:217-383-3171
Is Sole Proprietor?:No
Enumeration Date:2023-12-06
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209028648363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily