Provider Demographics
NPI:1801383211
Name:SCHWARZ, MARLA JOY (APN)
Entity type:Individual
Prefix:MRS
First Name:MARLA
Middle Name:JOY
Last Name:SCHWARZ
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1302 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SANDWICH
Mailing Address - State:IL
Mailing Address - Zip Code:60548-2587
Mailing Address - Country:US
Mailing Address - Phone:815-486-8484
Mailing Address - Fax:815-981-7375
Practice Address - Street 1:1302 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SANDWICH
Practice Address - State:IL
Practice Address - Zip Code:60548-2587
Practice Address - Country:US
Practice Address - Phone:815-486-8484
Practice Address - Fax:815-981-7375
Is Sole Proprietor?:No
Enumeration Date:2018-04-20
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.017515363LF0000X
IL277001157363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily