Individual
LUCY MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3401 N PERRYVILLE RD, ROCKFORD, IL 61114-8011
(815) 971-2000
Mailing address
3401 N PERRYVILLE RD, ROCKFORD, IL 61114-8011
(815) 971-2000
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
041269108
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
L90720
MEDICARE PRIOR 7/15/2007
IL
Enumeration date
02/06/2006
Last updated
11/24/2009
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