Basic Information
| Provider Information | |||||||||
| NPI: | 1245899749 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARTINEZ | ||||||||
| FirstName: | ANGELA | ||||||||
| MiddleName: | MERARI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3046 127TH ST | ||||||||
| Address2: | |||||||||
| City: | BLUE ISLAND | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604061827 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7083777920 | ||||||||
| FaxNumber: | 7089300414 | ||||||||
| Practice Location | |||||||||
| Address1: | 3046 127TH ST | ||||||||
| Address2: | |||||||||
| City: | BLUE ISLAND | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604061827 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7083777920 | ||||||||
| FaxNumber: | 7089300414 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2019 | ||||||||
| LastUpdateDate: | 06/07/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 2018077533 | IL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.