Provider Demographics
NPI:1154010353
Name:ESTRELLA, MARINA AURELIO (FNP)
Entity type:Individual
Prefix:
First Name:MARINA
Middle Name:AURELIO
Last Name:ESTRELLA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:MARINA
Other - Middle Name:CARBONEL
Other - Last Name:AURELIO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP
Mailing Address - Street 1:39356 N QUEENSBURY LN
Mailing Address - Street 2:
Mailing Address - City:BEACH PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60083-3018
Mailing Address - Country:US
Mailing Address - Phone:224-946-6859
Mailing Address - Fax:
Practice Address - Street 1:333 PETERSON RD STE 240
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-1085
Practice Address - Country:US
Practice Address - Phone:224-360-5020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-03
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209027706363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner