MEDICARE: JANET MARTIN FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	209.027183	IL

General Provider Information

NPI Number	:	1033801311
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANET MARTIN FNP

Provider Business Mailing Address
First Line	:	595 E PARK AVE
Second Line	:
City	:	ELMHURST
State	:	IL
Zip	:	60126-3658
Country	:	US
Telephone Number	:	630-240-6894
Fax Number	:

Provider Business Practice Location Address
First Line	:	676 N MICHIGAN AVE STE 3850
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60611-2863
Country	:	US
Telephone Number	:	312-642-4482
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2023
Last Update Date	:	05/24/2023

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