Provider Demographics
NPI:1710407309
Name:MALLARI, MARJORIE DELACHINA (RN)
Entity Type:Individual
Prefix:
First Name:MARJORIE
Middle Name:DELACHINA
Last Name:MALLARI
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3845 MCCOY DR STE 103
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-4429
Mailing Address - Country:US
Mailing Address - Phone:630-236-8800
Mailing Address - Fax:630-236-8802
Practice Address - Street 1:3845 MCCOY DR STE 103
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-4429
Practice Address - Country:US
Practice Address - Phone:630-236-8800
Practice Address - Fax:630-236-8802
Is Sole Proprietor?:No
Enumeration Date:2017-06-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041274031163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL251E00000XMedicaid