Provider Demographics
NPI:1902995749
Name:BARGER-MARCUSIU, EVA M (NP)
Entity Type:Individual
Prefix:
First Name:EVA
Middle Name:M
Last Name:BARGER-MARCUSIU
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:EVA
Other - Middle Name:M
Other - Last Name:BARGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:611 W. PARK ST.
Mailing Address - Street 2:FAPC
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:611 W PARK ST
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61801-2529
Practice Address - Country:US
Practice Address - Phone:217-383-3605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209004771363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200502310Medicaid
IN200502310Medicaid
ILIL3270073Medicare PIN
ILK13785Medicare ID - Type Unspecified