Provider Demographics
NPI:1639463870
Name:SANTOS MARTIN, KRISTINE (APN)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:
Last Name:SANTOS MARTIN
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:KRISTINE
Other - Middle Name:STELLA
Other - Last Name:SANTOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:225 E CHICAGO AVE # 69
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2991
Mailing Address - Country:US
Mailing Address - Phone:312-227-6190
Mailing Address - Fax:
Practice Address - Street 1:225 E CHICAGO AVE # 69
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2991
Practice Address - Country:US
Practice Address - Phone:312-227-6190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-06
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.008797363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics