Mary A Marvin, ACNS BC

Primary specialty

Adult Health Clinical Nurse SpecialistTaxonomy code 364SA2200X

License

041290023 Issued in IL

Practice address

530 NE Glen Oak Ave
Peoria, IL 61637-0001

Phone

(309) 671-1539

Fax

(309) 671-7528

NPI assigned

Aug 26, 2011

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Specialist

State licenses

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

{
    "created_epoch": "1314316800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1314316800000",
    "number": "1336429950",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 APPELLATE CT",
            "city": "EAST PEORIA",
            "state": "IL",
            "postal_code": "616111402",
            "telephone_number": "309-698-1195"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "530 NE GLEN OAK AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616370001",
            "telephone_number": "309-671-1539",
            "fax_number": "309-671-7528"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARVIN",
        "first_name": "MARY",
        "middle_name": "A",
        "name_prefix": "Miss",
        "credential": "ACNS BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-08-26",
        "last_updated": "2011-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "364SA2200X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Adult Health",
            "state": "IL",
            "license": "041290023",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tabitha Danielle Martin, LCSW
• Derek Martinez, M.D.
• Edmundo A Martinez, M.D,
• Julio C Martinez, RN
• Kayla C Martinez, PA-C
• Billy Ray Masco, MD
• Sean Masi, DO
• Joan L Mason, APN
• Vimal Master Sankar Raj, MD
• Trinity Hope Maston, LCPC

• Adult Health Clinical Nurse Specialist in Peoria, IL
• Providers in Peoria, IL by specialty
• Adult Health Clinical Nurse Specialist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.