Provider Demographics
NPI:1114755188
Name:MARTINEZ, MARIA ROSARIO (DNP)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:ROSARIO
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4419 N WHIPPLE ST APT 2A
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-3885
Mailing Address - Country:US
Mailing Address - Phone:773-829-2178
Mailing Address - Fax:
Practice Address - Street 1:2611 W CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-4519
Practice Address - Country:US
Practice Address - Phone:773-395-9900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-22
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041447815363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics