Provider Demographics
NPI:1265573117
Name:CIMINO, MARCELLA INGARRA (NP)
Entity type:Individual
Prefix:MRS
First Name:MARCELLA
Middle Name:INGARRA
Last Name:CIMINO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60108-1248
Mailing Address - Country:US
Mailing Address - Phone:630-980-9733
Mailing Address - Fax:
Practice Address - Street 1:1515 E LAKE ST
Practice Address - Street 2:
Practice Address - City:HANOVER PARK
Practice Address - State:IL
Practice Address - Zip Code:60133-4896
Practice Address - Country:US
Practice Address - Phone:630-830-5926
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics