MEDICARE: ROSEANGELA MARTINEZ NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	209034112	IL

General Provider Information

NPI Number	:	1285597468
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSEANGELA MARTINEZ NP

Provider Business Mailing Address
First Line	:	3445 N CENTRAL AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60634-4420
Country	:	US
Telephone Number	:	773-205-0800
Fax Number	:	773-205-1804

Provider Business Practice Location Address
First Line	:	3445 N CENTRAL AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60634-4420
Country	:	US
Telephone Number	:	773-205-0800
Fax Number	:	773-205-1804

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/04/2025
Last Update Date	:	12/04/2025

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