Provider Demographics
NPI:1457939159
Name:MARTYNOVA, IRINA
Entity type:Individual
Prefix:
First Name:IRINA
Middle Name:
Last Name:MARTYNOVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:706 S MILWAUKEE AVE
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:IL
Mailing Address - Zip Code:60090-6202
Mailing Address - Country:US
Mailing Address - Phone:847-457-8818
Mailing Address - Fax:847-457-4711
Practice Address - Street 1:706 S MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:IL
Practice Address - Zip Code:60090-6202
Practice Address - Country:US
Practice Address - Phone:847-457-8818
Practice Address - Fax:847-457-4711
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-01
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3002038253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care