Provider Demographics
NPI:1235534066
Name:MARTIN, ASHLEY M (APN)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:M
Last Name:MARTIN
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1601 WEST JACKSON STREET
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MACOMB
Mailing Address - State:IL
Mailing Address - Zip Code:61455
Mailing Address - Country:US
Mailing Address - Phone:309-575-3222
Mailing Address - Fax:309-404-8000
Practice Address - Street 1:1601 WEST JACKSON STREET
Practice Address - Street 2:SUITE 104
Practice Address - City:MACOMB
Practice Address - State:IL
Practice Address - Zip Code:61455
Practice Address - Country:US
Practice Address - Phone:309-575-3222
Practice Address - Fax:309-404-8000
Is Sole Proprietor?:No
Enumeration Date:2014-10-22
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL209012048363LP0808X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily