MEDICARE: MARTHA JANE GLYNN F.N.P.

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	209001404	IL

General Provider Information

NPI Number	:	1922113430
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARTHA JANE GLYNN F.N.P.

Provider Business Mailing Address
First Line	:	3030 N MOBILE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60634-4041
Country	:	US
Telephone Number	:	773-622-5679
Fax Number	:	773-622-5814

Provider Business Practice Location Address
First Line	:	3030 N MOBILE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60634-4041
Country	:	US
Telephone Number	:	773-622-5679
Fax Number	:	773-622-5814

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

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	03/06/2024

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