Provider Demographics
NPI:1225046972
Name:BARRY, MARTHA (CNM)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:
Last Name:BARRY
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3048 N WILTON AVE
Mailing Address - Street 2:NURSE MIDWIFERY SERVICE
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-6710
Mailing Address - Country:US
Mailing Address - Phone:773-296-7032
Mailing Address - Fax:773-296-3096
Practice Address - Street 1:3048 N WILTON AVE
Practice Address - Street 2:NURSE MIDWIFERY SERVICE
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-6710
Practice Address - Country:US
Practice Address - Phone:773-296-7032
Practice Address - Fax:773-296-3096
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife