Healthcare Provider Details

I. General information

NPI: 1447801998
Provider Name (Legal Business Name): GISELLE MARTINEZ-O'CONNOR MSN, APRN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2019
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1740 W TAYLOR ST
CHICAGO IL
60612-7232
US

IV. Provider business mailing address

17800 KEDZIE AVE
HAZEL CREST IL
60429-2029
US

V. Phone/Fax

Practice location:
  • Phone: 312-996-4008
  • Fax:
Mailing address:
  • Phone: 708-799-8000
  • Fax: 773-967-5808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number277005408
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number277005408
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: