Individual
MARTINE THERESE NELSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2745 MAPLE AVE, LISLE, IL 60532-3280
(630) 717-9600
(630) 717-5297
Mailing address
2745 MAPLE AVE, LISLE, IL 60532-3280
(630) 717-9600
(630) 717-5297
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
036067467
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036067467
—
IL
01
—
31601930
BLUE CROSS BLUE SHEILD
IL
Enumeration date
10/11/2006
Last updated
09/23/2008
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