| Doctor Name: | MARILYN MATTOX |
| NPI Number: | 1699986513 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 15709 Ellis Ave Dolton, IL - 604192718 |
| Business Phone Number: | 7088417746 |
| Business Fax Number: | 7088410381 |
| Mailing Address: | 15709 Ellis Ave, DOLTON |
| State: | IL |
| Postal Code: | 604192718 |
| Phone Number: | 7088417746 |
| Fax Number: | 7088410381 |
| NPI Enumeration Date: | 05/24/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WN0002X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Neonatal Intensive Care |
| Taxonomy Definition: | |