Healthcare Provider Details

I. General information

NPI: 1588580047
Provider Name (Legal Business Name): MARTHA ANN LEHMAN RN, NC-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2026
Last Update Date: 06/27/2026
Certification Date: 06/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

771 WILD OATS TRL
FREEPORT IL
61032-2806
US

IV. Provider business mailing address

771 WILD OATS TRL
FREEPORT IL
61032-2806
US

V. Phone/Fax

Practice location:
  • Phone: 815-291-8703
  • Fax:
Mailing address:
  • Phone: 815-291-8703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041.239183
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: