Provider Demographics
NPI:1376027318
Name:MARTIN, CYNTHIA DAWN (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:DAWN
Last Name:MARTIN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:332 S MICHIGAN AVE STE 1100
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60604-4416
Mailing Address - Country:US
Mailing Address - Phone:888-660-4425
Mailing Address - Fax:
Practice Address - Street 1:10426 S ROBERTS RD
Practice Address - Street 2:
Practice Address - City:PALOS HILLS
Practice Address - State:IL
Practice Address - Zip Code:60465-1932
Practice Address - Country:US
Practice Address - Phone:847-933-9200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-15
Last Update Date:2018-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209016978363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily