Marissa Mallinckrodt, NP

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

License

209.033716 Issued in IL

Practice address

505 Skokie Blvd
Wilmette, IL 60091-2131

Phone

(847) 893-1020

NPI assigned

Oct 29, 2025

Last updated

Oct 29, 2025By the provider in NPPES

Sex

Female

Sole proprietor

No

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)

Not enrolled

Credentials

Nurse Practitioner

State licenses

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

{
    "created_epoch": "1761696000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1761696000000",
    "number": "1821966961",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "505 SKOKIE BLVD",
            "city": "WILMETTE",
            "state": "IL",
            "postal_code": "600912131",
            "telephone_number": "847-893-1020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "505 SKOKIE BLVD",
            "city": "WILMETTE",
            "state": "IL",
            "postal_code": "600912131",
            "telephone_number": "847-893-1020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALLINCKRODT",
        "first_name": "MARISSA",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-10-29",
        "last_updated": "2025-10-29",
        "certification_date": "2025-10-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "IL",
            "license": "209.033716",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Denise Lynn Mackenzie, RPH
• Robert Madrigal, DDS
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• Jonathan H Maks, MD
• Megan Malyszek
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• Konstantino J Mantis, D.D.S.
• Stacey Anne Marguerite, PT

• Primary Care Nurse Practitioner in Wilmette, IL
• Providers in Wilmette, IL by specialty
• Primary Care Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2025; 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.