Provider Demographics
NPI:1215916788
Name:LAFF, MARIANNE (CNP APRN BC NP)
Entity type:Individual
Prefix:MRS
First Name:MARIANNE
Middle Name:
Last Name:LAFF
Suffix:
Gender:F
Credentials:CNP APRN BC NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2160 S 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:MAYWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60153-3328
Mailing Address - Country:US
Mailing Address - Phone:708-216-3156
Mailing Address - Fax:708-216-7853
Practice Address - Street 1:2160 S 1ST AVE
Practice Address - Street 2:
Practice Address - City:MAYWOOD
Practice Address - State:IL
Practice Address - Zip Code:60153-3328
Practice Address - Country:US
Practice Address - Phone:708-216-3156
Practice Address - Fax:708-216-7853
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209003791363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL938380Medicaid
ILK29847Medicare ID - Type Unspecified