MEDICARE: MARTIA CABALLERO RN

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	163W00000X	Registered Nurse	041290069	IL

General Provider Information

NPI Number	:	1801227525
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARTIA CABALLERO RN

Provider Business Mailing Address
First Line	:	6124 N MILWAUKEE AVE STE 7
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60646-3820
Country	:	US
Telephone Number	:	773-647-1291
Fax Number	:

Provider Business Practice Location Address
First Line	:	6124 N MILWAUKEE AVE STE 7
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60646-3820
Country	:	US
Telephone Number	:	773-647-1291
Fax Number	:	866-409-0243

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

Provider Enumeration Date	:	12/05/2013
Last Update Date	:	12/05/2013

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Directions to “ MARTIA CABALLERO RN” Practice Location

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