Provider Demographics
NPI:1073491346
Name:ARTABA, MARK ANTHONY (AGNP-C)
Entity type:Individual
Prefix:MR
First Name:MARK ANTHONY
Middle Name:
Last Name:ARTABA
Suffix:
Gender:M
Credentials:AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2930 N PINE GROVE AVE APT 101
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-5754
Mailing Address - Country:US
Mailing Address - Phone:616-416-5906
Mailing Address - Fax:
Practice Address - Street 1:6841 N FRANCISCO AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60645-2927
Practice Address - Country:US
Practice Address - Phone:929-491-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-25
Last Update Date:2025-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041541036163WW0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WW0000XNursing Service ProvidersRegistered NurseWound Care