Healthcare Provider Details

I. General information

NPI: 1467294835
Provider Name (Legal Business Name): ELVIRAIDA MARTINEZ FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELVIRAIDA MARTINEZ FNP-C

II. Dates (important events)

Enumeration Date: 06/07/2024
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6201 W HOWARD ST STE 211A
NILES IL
60714-3435
US

IV. Provider business mailing address

6201 W HOWARD ST STE 211A
NILES IL
60714-3435
US

V. Phone/Fax

Practice location:
  • Phone: 773-263-1254
  • Fax:
Mailing address:
  • Phone: 773-263-1254
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF07250616
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: