Individual provider · Type 1 NPI
Mary Theodosopoulos
Nurse Practitioner · Evanston, IL
Practice location
1409 Madison St
Evanston, IL 60202-2138
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Nurse Practitioner Primary | 363L00000X | 209.033529 (IL) |
Nurse Practitioner: (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance wit…
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About NPI 1932075207
Mary Theodosopoulos's National Provider Identifier is 1932075207, issued on Oct 14, 2025. The primary taxonomy on file is Nurse Practitioner (363L00000X), and the practice location is in Evanston, IL. The record was last updated on Oct 24, 2025.