Provider Demographics
NPI:1184053415
Name:HORNE, MARSHANELLE (APN,FNP-BC)
Entity type:Individual
Prefix:
First Name:MARSHANELLE
Middle Name:
Last Name:HORNE
Suffix:
Gender:F
Credentials:APN,FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 LAKE ST STE 101
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60301-1424
Mailing Address - Country:US
Mailing Address - Phone:708-358-0791
Mailing Address - Fax:
Practice Address - Street 1:720 LAKE ST
Practice Address - Street 2:SUITE 101
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301-1424
Practice Address - Country:US
Practice Address - Phone:708-358-0791
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-07
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209010847363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily