Provider Demographics
NPI:1861963407
Name:POWERS ROSS, MARCIE NESHIA (APRN, FNP)
Entity type:Individual
Prefix:
First Name:MARCIE
Middle Name:NESHIA
Last Name:POWERS ROSS
Suffix:
Gender:F
Credentials:APRN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 TRANSAM PLAZA DR STE 410
Mailing Address - Street 2:
Mailing Address - City:OAKBROOK TERRACE
Mailing Address - State:IL
Mailing Address - Zip Code:60181-4290
Mailing Address - Country:US
Mailing Address - Phone:312-493-5467
Mailing Address - Fax:
Practice Address - Street 1:2 TRANSAM PLAZA DR STE 410
Practice Address - Street 2:
Practice Address - City:OAKBROOK TERRACE
Practice Address - State:IL
Practice Address - Zip Code:60181-4290
Practice Address - Country:US
Practice Address - Phone:312-493-5467
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-07
Last Update Date:2021-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041378507163WC0400X
IL209019095363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WC0400XNursing Service ProvidersRegistered NurseCase Management