MARLON PEMBERTON (NPI# 1942746185) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1942746185 |
| Entity Type | Individual |
| Full Name | MARLON PEMBERTON |
| Practice Address |
1604 Visa Dr Ste 1 Normal IL 61761-2195 |
| Practice Telephone | 3094541100 |
| Practice Fax Number | 3094541107 |
| Mailing Telephone | 3094541100 |
| Mailing Fax Number | 3094541107 |
| Enumeration Date | 2017-01-11 |
| Last Update Date | 2017-01-11 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 246QM0706X |
Spec/Tech, Pathology Specialization: Medical Technologist |
246ZE0600X | NY | Technologists, Technicians & Other Technical Service Providers |
| Street Address |
1604 VISA DR STE 1 |
| City | NORMAL |
| State | IL |
| Zip Code | 61761-2195 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467583955 | Neuromonitoring Service LLC | Physical Medicine & Rehabilitation | 1604 Visa Dr Ste 1, Normal, IL 61761-2195 | 2007-03-08 |
| 1063012789 | Heston J Allred | Specialist/Technologist, Other | 1604 Visa Dr Ste 1, Normal, IL 61761-2195 | 2020-10-30 |
| 1821607284 | Korine M Tatroe | Specialist/Technologist, Other | 1604 Visa Dr Ste 1, Normal, IL 61761-2195 | 2020-07-30 |
| 1154961092 | Desiree A Padilla | Specialist/Technologist, Other | 1604 Visa Dr Ste 1, Normal, IL 61761-2195 | 2020-01-08 |
| 1538714191 | Douglas S Holt | Specialist/Technologist, Other | 1604 Visa Dr Ste 1, Normal, IL 61761-2195 | 2019-08-09 |
| 1316204266 | Sidney E Kessinger | Specialist/Technologist, Other | 1604 Visa Dr Ste 1, Normal, IL 61761-2195 | 2012-04-17 |
| 1962706275 | Shawna Summers | Specialist/Technologist, Other | 1604 Visa Dr Ste 1, Normal, IL 61761-2195 | 2010-12-29 |
| 1639471113 | Stephanie Sprague | Specialist/Technologist, Other | 1604 Visa Dr Ste 1, Normal, IL 61761-2195 | 2010-12-03 |
| 1194958330 | Julie L Dieterman | Registered Nurse | 1604 Visa Dr Ste 1, Normal, IL 61761-2195 | 2009-09-03 |
| 1740414648 | Rosalie Ann Reason | Specialist/Technologist, Other | 1604 Visa Dr Ste 1, Normal, IL 61761-2195 | 2009-05-06 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629681796 | Brittany Nicole Mekley | Nurse Practitioner | 201 N. University, Normal, IL 61761 | 2020-08-28 |
| 1679108971 | Krystal Halliday | Occupational Therapist | 1815 N Towanda Barnes Rd, Normal, IL 61761 | 2020-03-06 |
| 1265915474 | Laine E Burek | Nurse Practitioner | 1765 Bradford Ln., Normal, IL 61761 | 2018-09-13 |
| 1801389986 | Ashley Michelle James | Specialist/Technologist | 347 S. University St, Normal, IL 61761 | 2018-06-12 |
| 1447750708 | Shelley R. Ruch | Specialist/Technologist, Other | 1604 Visa Drive, Ste 1, Normal, IL 61761 | 2018-02-13 |
| 1497275069 | Mclean County Nursing Home | Non-emergency Medical Transport (VAN) | 901 N. Main St, Normal, IL 61761 | 2017-06-23 |
| 1235673666 | Megan Threm | Registered Nurse | 900 Franklin Ave Community Health Care Clinic, Normal, IL 61761 | 2016-12-04 |
| 1437513553 | Tiesha Smith | Specialist | 1800 Rockingham Dr, Apt 1d, Normal, IL 61761 | 2016-04-06 |
| 1285031658 | New Day Recovery | Community/Behavioral Health | 402 Summit, Normal, IL 61761 | 2014-12-01 |
| 1174927701 | Alyssa Marie Bruck | Occupational Therapist | 700 N Walnut St, Normal, IL 61761 | 2014-10-10 |
| Find all providers in zip 61761 | ||||
| Taxonomy Code | 246QM0706X |
| Grouping | Technologists, Technicians & Other Technical Service Providers |
| Classification | Spec/Tech, Pathology |
| Specialization | Medical Technologist |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073017679 | Nicholas M Moore | Spec/Tech, Pathology | 1653 W Congress Pkwy Ste 1173, Chicago, IL 60612-3833 | 2018-03-20 |
| 1497280291 | Guinevere B Reserva | Spec/Tech, Pathology | 515 Sawmill Ct, Rochester, IL 62563-6057 | 2017-04-29 |
| 1689069189 | Lucas Quinlan | Spec/Tech, Pathology | 2172 County Road 3500 N, Ludlow, IL 60949-6028 | 2015-04-01 |
| 1346591260 | Timothy Leland Toner | Spec/Tech, Pathology | 304 N Dixon St, Rankin, IL 60960-7057 | 2012-10-02 |
| 1518232537 | Dana White | Spec/Tech, Pathology | 27 Bonniebrook Rd, Chatham, IL 62629-1066 | 2012-03-09 |
| 1720378524 | Star Lab, Inc | Spec/Tech, Pathology | 9213 Parklane Ave, Franklin Park, IL 60131-2837 | 2011-04-13 |
| 1124413653 | Angelica Hochevar | Spec/Tech, Pathology | 5000 S 5th Ave, Hines, IL 60141-3030 | 2015-04-01 |
| 1093070880 | Marbie Downen | Spec/Tech, Pathology | 801 S West St, Executive Center Suite 123, Olney, IL 62450-1334 | 2012-07-09 |
| 1508139734 | Carlomagno A Ore | Spec/Tech, Pathology | 1653 W Congress Pkwy, Chicago, IL 60612-3833 | 2012-02-19 |
| 1215102157 | Edith M Siemianowski | Spec/Tech, Pathology | 5000 S 5th Ave, Microbiology 113, Hines, IL 60141-3030 | 2008-04-22 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.