Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Mrs. Marina Deatherage

Individual provider Family Nurse Practitioner · NPI 1538706858

Mrs. Marina Deatherage is a Nurse Practitioner in Lake Geneva, Wisconsin. Qualified in 2019, 7 years ago. Practices with Aurora Medical Group, Inc, a 3,741-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Illinois and Wisconsin.

Years since qualifying
7
Licensed in
IL, WI
In the registry since
2019
Specialties on file
2

Practice location Address checks out

146 E Geneva Sq
Lake Geneva, WI 53147-9694
Phone: (262) 249-4660
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 3915 Oglesby Ave, Gurnee, IL 60031-3358 — (847) 336-1600

Specialties & licences

Nurse Practitioner (primary) Taxonomy 363L00000X · Licence 10857-033 (WI)
Family Nurse Practitioner Taxonomy 363LF0000X · Licence 209020317 (IL)

Record details

NPI number1538706858
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedDecember 5, 2019
Last updated in NPPESNovember 30, 2021
Certification dateNovember 30, 2021

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2019 (7 years in practice)
Group practice Aurora Medical Group, Inc. — 3741 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

Other providers in Lake Geneva