Miriam Manrique

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

209.029153 Issued in IL

Practice address

321 N la Grange Rd
La Grange Park, IL 60526-5622

Phone

(708) 745-5277

NPI assigned

Mar 19, 2024

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Pillars Community Health

  • Federally Qualified Health Center (FQHC)
  • La Grange Park, IL
  • NPI 1174878813
  NPD (past)
• Pillars Community Health

  • Federally Qualified Health Center (FQHC)
  • Summit, IL
  • NPI 1235835018
  NPD (past)
• Pillars Community Health

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • La Grange Park, IL
  • NPI 1467296541
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1710806400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722902400000",
    "number": "1104686203",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5220 EAST AVE",
            "city": "COUNTRYSIDE",
            "state": "IL",
            "postal_code": "605253133",
            "telephone_number": "708-745-5277"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "321 N LA GRANGE RD",
            "city": "LA GRANGE PARK",
            "state": "IL",
            "postal_code": "605265622",
            "telephone_number": "708-745-5277"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANRIQUE",
        "first_name": "MIRIAM",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-03-19",
        "last_updated": "2024-08-06",
        "certification_date": "2024-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": "209.029153",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Berenice Lopez, DDS
• Susan Lyons, R.N., I.B.C.L.C.
• Anna Mahay
• Ananya Malcha
• Todd Dino Manolis, D.D.S.
• Nina Marco
• Isis Martin
• Kathleen Elizabeth Mattingly, RN
• Gary Myles McCray, M.D.
• Margaret McElherne, SLP, CCC

• Nurse Practitioner in La Grange Park, IL
• Providers in La Grange Park, IL by specialty
• Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.