Provider Demographics
NPI:1144692021
Name:MARCUS, CALLAN (APN)
Entity type:Individual
Prefix:
First Name:CALLAN
Middle Name:
Last Name:MARCUS
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1449 N ASHLAND AVE
Mailing Address - Street 2:APT 3R
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-2269
Mailing Address - Country:US
Mailing Address - Phone:913-481-4201
Mailing Address - Fax:
Practice Address - Street 1:2007 95TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-8459
Practice Address - Country:US
Practice Address - Phone:630-646-6593
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-30
Last Update Date:2019-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209013352363LF0000X
COAPN.0993388-NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily