Basic Information
| Provider Information | |||||||||
| NPI: | 1639384506 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARTIN | ||||||||
| FirstName: | DEBORAH | ||||||||
| MiddleName: | CHRISTINE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | RNC, NNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 125 JARDIN CERCLE | ||||||||
| Address2: | |||||||||
| City: | HIGHLAND | ||||||||
| State: | IL | ||||||||
| PostalCode: | 622494708 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6189788174 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 9515 HOLY CROSS LN | ||||||||
| Address2: | |||||||||
| City: | BREESE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 622303618 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6185264511 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/13/2007 | ||||||||
| LastUpdateDate: | 12/27/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/12/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LN0005X | 112468 | MO | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Neonatal, Critical Care | 363LN0000X | 209012640 | IL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Neonatal |
No ID Information.