Basic Information
| Provider Information | |||||||||
| NPI: | 1710236815 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DE LA PAZ | ||||||||
| FirstName: | MARISSA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MISS | ||||||||
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| Credential: | ANP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 808 E WOODFIELD RD STE 100 | ||||||||
| Address2: | |||||||||
| City: | SCHAUMBURG | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601734836 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8476050030 | ||||||||
| FaxNumber: | 8476370737 | ||||||||
| Practice Location | |||||||||
| Address1: | 804 E. WOODFIELD ROAD | ||||||||
| Address2: | 300 | ||||||||
| City: | SCHAUMBURG | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60173 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8476059500 | ||||||||
| FaxNumber: | 8476058700 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/05/2012 | ||||||||
| LastUpdateDate: | 09/12/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 209009695 | IL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.