Individual
JACQUELINE MARTINEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
2875 W 19TH ST, CHICAGO, IL 60623-3596
(312) 402-6878
Mailing address
2875 W 19TH ST, CHICAGO, IL 60623-3596
(312) 402-6878
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
209.023124
IL
Other
Enumeration date
04/07/2022
Last updated
02/28/2023
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