Mary Eileen Roth, FNP-BC
Nurse Practitioner, Family in Chicago, IL. Individual provider (NPI-1).
NPI number1164094843
StatusActive
Last updated in NPPESAug 27, 2026
Details
- NPI
- 1164094843
- Entity type
- Individual (NPI-1)
- Name
- Mary Eileen Roth
- Credential
- FNP-BC
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Jul 13, 2021
- Certification date
- Aug 27, 2026
- Last updated
- Aug 27, 2026
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363LF0000X | Nurse Practitioner, Family | 209034461 | IL | Yes |
Other names
- Mary Eileen Gerardo (Former Name)
Practice location
344 W Hubbard StChicago, IL 60654-4407
Phone 312-222-2570
Mailing address
2446 N Racine Ave Apt 1fChicago, IL 60614-3404
Phone 804-658-8536
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