Provider Demographics
NPI:1841735222
Name:DOUBEK, MARIALUISA (FNP)
Entity Type:Individual
Prefix:
First Name:MARIALUISA
Middle Name:
Last Name:DOUBEK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:MARIALUISA
Other - Middle Name:
Other - Last Name:CAMPOS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP
Mailing Address - Street 1:2001 S CALIFORNIA AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-2486
Mailing Address - Country:US
Mailing Address - Phone:773-584-6200
Mailing Address - Fax:
Practice Address - Street 1:6550 S RICHMOND ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60629-2821
Practice Address - Country:US
Practice Address - Phone:773-309-4445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-21
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209014130363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily