Provider Demographics
NPI:1427270206
Name:HART, MARILOU VALENCIA (RN)
Entity type:Individual
Prefix:MRS
First Name:MARILOU
Middle Name:VALENCIA
Last Name:HART
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6450 W BERTEAU AVE
Mailing Address - Street 2:UNIT 513
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-6242
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6801 W HIGGINS AVE
Practice Address - Street 2:SUITE C
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60656-2009
Practice Address - Country:US
Practice Address - Phone:773-774-5460
Practice Address - Fax:773-774-5461
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health