Individual
SAMANTHA MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AGACNP-BC
Contact information
Practice address
ADDRESS: 530 NE GLEN OAK AVE, PEORIA, IL 61637-0001
(309) 655-2000
Mailing address
5804 MONMARTE CV, AUSTIN, TX 78744-5903
(309) 397-2698
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
209022870
IL
363LG0600X
Gerontology Nurse Practitioner
209022870
IL
Other
Enumeration date
06/23/2021
Last updated
06/23/2021
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