Provider Demographics
NPI:1861658676
Name:MARTIN, NANCY ELIZABETH (MD, PHARMD, FCP)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:ELIZABETH
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MD, PHARMD, FCP
Other - Prefix:DR
Other - First Name:NANCY
Other - Middle Name:ELIZABETH
Other - Last Name:ALGRANATI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD, PHARMD, FCP
Mailing Address - Street 1:327 SHERIDAN RD
Mailing Address - Street 2:
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-3453
Mailing Address - Country:US
Mailing Address - Phone:224-515-6177
Mailing Address - Fax:
Practice Address - Street 1:327 SHERIDAN RD
Practice Address - Street 2:
Practice Address - City:WILMETTE
Practice Address - State:IL
Practice Address - Zip Code:60091-3453
Practice Address - Country:US
Practice Address - Phone:224-515-6177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-31
Last Update Date:2014-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02575400183500000X
IL051286184183500000X
NY260054207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No183500000XPharmacy Service ProvidersPharmacist