Healthcare Provider Details

I. General information

NPI: 1942838578
Provider Name (Legal Business Name): MAY MARTIN FNP BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2020
Last Update Date: 05/07/2021
Certification Date: 05/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 N CICERO AVE STE 600
CHICAGO IL
60646-5721
US

IV. Provider business mailing address

1070 HIGGINS RD UNIT B
PARK RIDGE IL
60068-5744
US

V. Phone/Fax

Practice location:
  • Phone: 773-545-9200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number041382874
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209020740
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: