Provider Demographics
NPI:1730325226
Name:SCHANKS, MARINA DIANE (NP-C)
Entity type:Individual
Prefix:MRS
First Name:MARINA
Middle Name:DIANE
Last Name:SCHANKS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:MRS
Other - First Name:MARINA
Other - Middle Name:DIANE
Other - Last Name:DE ASA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:REGISTERED NURSE
Mailing Address - Street 1:1000 REMINGTON BLVD
Mailing Address - Street 2:STE 100
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4707
Mailing Address - Country:US
Mailing Address - Phone:773-296-5019
Mailing Address - Fax:773-296-8909
Practice Address - Street 1:836 WEST WELLINGTON AVENUE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-5193
Practice Address - Country:US
Practice Address - Phone:773-296-5019
Practice Address - Fax:773-296-8909
Is Sole Proprietor?:No
Enumeration Date:2009-01-05
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209007264041237430363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner