MEDICARE: MAY MARTIN FNP BC

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	163WC0200X	Critical Care Medicine Registered Nurse	041382874	IL
2	363LF0000X	Family Nurse Practitioner	209020740	IL

General Provider Information

NPI Number	:	1942838578
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAY MARTIN FNP BC

Provider Business Mailing Address
First Line	:	1070 HIGGINS RD UNIT B
Second Line	:
City	:	PARK RIDGE
State	:	IL
Zip	:	60068-5744
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5901 N CICERO AVE STE 600
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60646-5721
Country	:	US
Telephone Number	:	773-545-9200
Fax Number	:

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

Provider Enumeration Date	:	03/30/2020
Last Update Date	:	05/07/2021

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