Healthcare Provider Details

I. General information

NPI: 1932912490
Provider Name (Legal Business Name): IZEL MARTINEZ FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2025
Last Update Date: 01/29/2025
Certification Date: 01/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2955 W 95TH ST
EVERGREEN PARK IL
60805-2409
US

IV. Provider business mailing address

5916 W 87TH ST APT 2D
BURBANK IL
60459-2568
US

V. Phone/Fax

Practice location:
  • Phone: 708-422-1363
  • Fax: 708-422-1256
Mailing address:
  • Phone: 773-414-1140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209031075
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: