Provider Demographics
NPI:1689750846
Name:MACKOWIAK LINDEMAN, MARILYN E (RNC-ANP)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:E
Last Name:MACKOWIAK LINDEMAN
Suffix:
Gender:F
Credentials:RNC-ANP
Other - Prefix:
Other - First Name:MARILYN
Other - Middle Name:E
Other - Last Name:MACKOWIAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RNC-ANP
Mailing Address - Street 1:1570 ASBURY AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-4173
Mailing Address - Country:US
Mailing Address - Phone:847-869-0698
Mailing Address - Fax:
Practice Address - Street 1:5841 S MARYLAND AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-1447
Practice Address - Country:US
Practice Address - Phone:773-702-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL41-136229363LA2200X
IL209-002173363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health