Provider Demographics
NPI:1205261682
Name:MARCIN, GINA MARIE (APN, CNM, LAC)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:MARIE
Last Name:MARCIN
Suffix:
Gender:F
Credentials:APN, CNM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1051 W RAND RD STE 101
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-2315
Mailing Address - Country:US
Mailing Address - Phone:847-221-4900
Mailing Address - Fax:847-221-4996
Practice Address - Street 1:1051 W RAND RD STE 101
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-2315
Practice Address - Country:US
Practice Address - Phone:847-221-4900
Practice Address - Fax:847-221-4996
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-04
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198.000527171100000X
IL209.010580367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209010580OtherSTATE LICENSE