Individual
MARY MARTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1010 N HOOKER ST, SUITE 301, CHICAGO, IL 60642-4549
(312) 943-3600
Mailing address
1010 N HOOKER ST, SUITE 301, CHICAGO, IL 60642-4549
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
041268375
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
041268375
STATE LICENSE
IL
Enumeration date
04/27/2015
Last updated
04/27/2015
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