Provider Demographics
NPI:1528724762
Name:MARZ, KEEGAN L (APN-CNP)
Entity type:Individual
Prefix:MS
First Name:KEEGAN
Middle Name:L
Last Name:MARZ
Suffix:
Gender:F
Credentials:APN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2150 PFINGSTEN RD STE 1200
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026-1326
Mailing Address - Country:US
Mailing Address - Phone:847-663-8410
Mailing Address - Fax:
Practice Address - Street 1:2150 PFINGSTEN RD STE 1200
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60026-1326
Practice Address - Country:US
Practice Address - Phone:847-663-8410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-11
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209023935363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner