| Doctor Name: | MS. JACQUELINE LEE MARCHBANK |
| NPI Number: | 1750767604 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | APN |
| License Number: | 209012785 |
| Business Practice Address: | 13011 S 104th Ave Suite 100 Palos Park, IL - 604641506 |
| Business Phone Number: | 7084783600 |
| Business Fax Number: | 7084783552 |
| Mailing Address: | 13011 S 104th Ave, Suite 100 PALOS PARK |
| State: | IL |
| Postal Code: | 604641506 |
| Phone Number: | 7084783600 |
| Fax Number: | 7084783552 |
| NPI Enumeration Date: | 08/03/2015 |
| NPI Last Update Date: | 08/03/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 209012785 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |