Provider Demographics
NPI:1992034425
Name:DELIBERTO, MARY ANN (RN, APN)
Entity Type:Individual
Prefix:MS
First Name:MARY ANN
Middle Name:
Last Name:DELIBERTO
Suffix:
Gender:F
Credentials:RN, APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 S FRONTAGE RD
Mailing Address - Street 2:SUITE 325
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-4903
Mailing Address - Country:US
Mailing Address - Phone:847-981-3680
Mailing Address - Fax:847-956-5122
Practice Address - Street 1:800 BIESTERFIELD RD STE G01
Practice Address - Street 2:WIMMER BUILDING
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007-3372
Practice Address - Country:US
Practice Address - Phone:847-981-3680
Practice Address - Fax:847-956-5122
Is Sole Proprietor?:No
Enumeration Date:2009-12-11
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041197941163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1720371669OtherNPI GROUP PRACTICE
ILIL6304004OtherMEDICARE PTAN LOC 16
ILIL6305004OtherMEDICARE PTAN LOC 15