Provider Demographics
NPI:1992721757
Name:JOSEPH, MARY J (APN-CNP)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:J
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:APN-CNP
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Mailing Address - Street 1:4851 HOWARD ST
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-2809
Mailing Address - Country:US
Mailing Address - Phone:847-673-5451
Mailing Address - Fax:312-864-9765
Practice Address - Street 1:1901 W HARRISON ST
Practice Address - Street 2:DEPT OF CARDIOLOGY ROOM# 2772, JOHN STROGER HOSPITAL OF
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3714
Practice Address - Country:US
Practice Address - Phone:213-864-3416
Practice Address - Fax:312-864-9765
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2007-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04192472Medicare UPIN