Provider Demographics
NPI:1992984975
Name:SNOOK, MARILYN (PA)
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:
Last Name:SNOOK
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 MCCLINTOCK DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-0844
Mailing Address - Country:US
Mailing Address - Phone:888-220-6432
Mailing Address - Fax:630-654-4253
Practice Address - Street 1:1300 FRANKLIN AVE
Practice Address - Street 2:SUITE 230-C
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761-3588
Practice Address - Country:US
Practice Address - Phone:888-220-6432
Practice Address - Fax:309-268-2952
Is Sole Proprietor?:No
Enumeration Date:2007-10-26
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085-003110363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK46970Medicare PIN
ILK46971Medicare PIN
ILK46969Medicare PIN