Provider Demographics
NPI:1609654284
Name:KRONE, MARTINA JACOBSEN (WHNP-BC)
Entity Type:Individual
Prefix:
First Name:MARTINA
Middle Name:JACOBSEN
Last Name:KRONE
Suffix:
Gender:F
Credentials:WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:631 LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-1721
Mailing Address - Country:US
Mailing Address - Phone:224-456-0868
Mailing Address - Fax:
Practice Address - Street 1:1 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-2335
Practice Address - Country:US
Practice Address - Phone:847-298-3150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-15
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000265512163W00000X
IL209028607363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163W00000XNursing Service ProvidersRegistered Nurse