MEDICARE: GUINEVERE G SAMMARTINO FNP-C

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	363L00000X	Nurse Practitioner	209031809	IL
2	363LF0000X	Family Nurse Practitioner	209.031809	IL

General Provider Information

NPI Number	:	1427851328
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GUINEVERE G SAMMARTINO FNP-C

Provider Business Mailing Address
First Line	:	2650 RIDGE AVE STE 1223
Second Line	:
City	:	EVANSTON
State	:	IL
Zip	:	60201-1700
Country	:	US
Telephone Number	:	847-570-2040
Fax Number	:	847-570-5315

Provider Business Practice Location Address
First Line	:	2650 RIDGE AVE
Second Line	:	EMERGENCY MEDICINE
City	:	EVANSTON
State	:	IL
Zip	:	60201
Country	:	US
Telephone Number	:	847-570-2114
Fax Number	:	847-570-1223

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

Provider Enumeration Date	:	03/28/2025
Last Update Date	:	12/15/2025

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